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General NPI Number Information
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NPI Number | 1962366104
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Entity Type | Organization
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Legal Business Name | U1ST FOUNDATION
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Dates
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Enumeration Date | 12/11/2025
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 3118 WILLIAMSBURG ST NW
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City | WARREN
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State | OH
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Zip | 44485-2255
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Country | US
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Telephone | 330-647-9792
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Fax |
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Provider Business Mailing Address
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Address Line | 3118 WILLIAMSBURG ST NW
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City | WARREN
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State | OH
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Zip | 44485-2255
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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 | FOUNDER
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Name | EBONIE BOURGOIN
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Credential |
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Telephone | 330-647-9792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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