=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376862128
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIQUECARE HOME HEALTH SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2010
-----------------------------------------------------
Last Update Date | 05/19/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2842 BELLWOOD AVE
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43209-1130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-235-4877
-----------------------------------------------------
Fax | 614-235-4877
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2842 BELLWOOD AVE
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43209-1130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-235-4877
-----------------------------------------------------
Fax | 614-235-4877
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. DOLORES DEE LANGA
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 614-235-4877
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | RN210360
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------