=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164488334
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNICARE HOME HEALTH SERVICES OF TYLER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2006
-----------------------------------------------------
Last Update Date | 08/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3300 S BROADWAY AVE STE 208
-----------------------------------------------------
City | TYLER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75701-7818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-531-9949
-----------------------------------------------------
Fax | 903-531-9951
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3300 S BROADWAY AVE STE 208
-----------------------------------------------------
City | TYLER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75701-7818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-531-9949
-----------------------------------------------------
Fax | 903-531-9951
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. MINI PRINCE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 903-531-9949
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 006918
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------