=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659020246
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITY FAMILY HEALTHCARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2022
-----------------------------------------------------
Last Update Date | 03/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 815 2ND ST SE
-----------------------------------------------------
City | LITTLE FALLS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56345-3505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-238-3206
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 815 2ND ST SE
-----------------------------------------------------
City | LITTLE FALLS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56345-3505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-238-3206
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | NICOLE PERYERL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 701-238-3206
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------