=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366658742
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITED COMMUNITY & FAMILY SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 165 MCKINLEY AVE
-----------------------------------------------------
City | NORWICH
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06360-3509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-887-5055
-----------------------------------------------------
Fax | 860-892-2340
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 165 MCKINLEY AVE
-----------------------------------------------------
City | NORWICH
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06360-3509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-887-5055
-----------------------------------------------------
Fax | 860-892-2340
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | MRS. JULIE SHAW
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 860-889-2375
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number | 1268-RCH
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------