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General NPI Number Information
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NPI Number | 1710330550
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Entity Type | Organization
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Legal Business Name | DARLEEN UNIQUE PROVIDER SERVICES,LLC
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Dates
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Enumeration Date | 07/17/2016
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Last Update Date | 08/04/2021
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Provider Practice Location Address
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Address Line | 681 SW FREDRICA ST
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34983-1875
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Country | US
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Telephone | 954-655-9682
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Fax |
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Provider Business Mailing Address
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Address Line | 681 SW FREDRICA ST
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34983-1875
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Country | US
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Telephone | 954-655-9682
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | DARLENE DESSOURCES
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Credential |
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Telephone | 954-655-9682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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