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General NPI Number Information
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NPI Number | 1689373136
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Entity Type | Organization
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Legal Business Name | UNIQUE 403 LLC
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Dates
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Enumeration Date | 02/23/2023
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Last Update Date | 02/23/2023
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Provider Practice Location Address
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Address Line | 5303 WALKER CT SW
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City | MABLETON
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State | GA
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Zip | 30126-2207
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Country | US
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Telephone | 470-871-4840
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 961
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City | MABLETON
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State | GA
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Zip | 30126-0961
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Country | US
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Telephone | 678-614-5444
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MONIQUE D LEGETTE
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Credential | CNA
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Telephone | 470-871-4840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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