=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689030355
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITY CAREGROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2016
-----------------------------------------------------
Last Update Date | 01/11/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3957 SEVEN TREES BLVD APT 175
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95111-4416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-625-0662
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3957 SEVEN TREES BLVD APT 175
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95111-4416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RESIDENTIAL COUNSELOR
-----------------------------------------------------
Name | MR. RODNEY D HOLLAND JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 408-625-0662
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 322D00000X
-----------------------------------------------------
Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
-----------------------------------------------------
License Number | 322D00000X
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------