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General NPI Number Information
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NPI Number | 1710400106
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Entity Type | Organization
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Legal Business Name | UNICORN SUPPORTIVE SERVICES
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 07/21/2017
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Provider Practice Location Address
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Address Line | 22 VALLEY FORGE DR
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City | SWEDESBORO
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State | NJ
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Zip | 08085-4230
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Country | US
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Telephone | 856-278-5188
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Fax |
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Provider Business Mailing Address
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Address Line | 22 VALLEY FORGE DR
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City | SWEDESBORO
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State | NJ
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Zip | 08085-4230
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MONDAY J GABRIEL
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Credential |
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Telephone | 856-278-5188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number |
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State | NJ
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Taxonomy #5
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State | NJ
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