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General NPI Number Information
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NPI Number | 1417253618
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Entity Type | Organization
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Legal Business Name | MISSION UNITY INC
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Dates
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Enumeration Date | 02/04/2011
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Last Update Date | 05/02/2013
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Provider Practice Location Address
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Address Line | 3512 DEPEW AVE
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-7015
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Country | US
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Telephone | 941-286-1158
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Fax | 800-867-1804
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Provider Business Mailing Address
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Address Line | 3512 DEPEW AVE
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-7015
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Country | US
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Telephone | 941-286-1158
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Fax | 800-867-1804
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | LINDA RITTER
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Credential | R.N.
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Telephone | 941-286-1158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 2008AD2477-01
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License Number State | FL
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