MEDICARE: UNLIMITED SUPPORTS & CONSULTING AGENCY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	251S00000X	Community/Behavioral Health Agency
3	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1164384087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNLIMITED SUPPORTS & CONSULTING AGENCY LLC

Provider Business Mailing Address
First Line	:	5103 MALLISON WAY
Second Line	:
City	:	MC LEANSVILLE
State	:	NC
Zip	:	27301-9004
Country	:	US
Telephone Number	:	336-303-6922
Fax Number	:	336-303-6922

Provider Business Practice Location Address
First Line	:	5103 MALLISON WAY
Second Line	:
City	:	MC LEANSVILLE
State	:	NC
Zip	:	27301-9004
Country	:	US
Telephone Number	:	336-303-6922
Fax Number	:	336-303-6922

Authorized Official
Title or Position	:	OWNER
Name	:	LATOYA CELESTE TATE
Credential	:
Telephone Number	:	336-303-6922

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/18/2025

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