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General NPI Number Information
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NPI Number | 1770096810
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Entity Type | Organization
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Legal Business Name | UNLAND LLC
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Dates
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Enumeration Date | 11/12/2017
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Last Update Date | 11/12/2017
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Provider Practice Location Address
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Address Line | 2401 LONGWOOD DR APT N
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City | REEDSPORT
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State | OR
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Zip | 97467-1162
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Country | US
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Telephone | 417-280-6941
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Fax | 314-499-9047
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Provider Business Mailing Address
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Address Line | 2401 LONGWOOD DR APT N
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City | REEDSPORT
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State | OR
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Zip | 97467-1162
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Country | US
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Telephone | 417-280-6941
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Fax | 314-499-9047
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Authorized Official
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Title or Position | MANAGER
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Name | VIRGINIA LEE UNDERWOOD
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Credential | RN
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Telephone | 417-280-6941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 201502205
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 201502205
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License Number State | OR
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