MEDICARE: A UNIQUE FAMILY UNDIVIDED LLC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1427825330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A UNIQUE FAMILY UNDIVIDED LLC.

Provider Business Mailing Address
First Line	:	2241 16TH ST NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44705-2001
Country	:	US
Telephone Number	:	330-915-0049
Fax Number	:

Provider Business Practice Location Address
First Line	:	2241 16TH ST NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44705-2001
Country	:	US
Telephone Number	:	330-915-0049
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	ASHLEY DAVENPORT
Credential	:
Telephone Number	:	330-915-0049

Provider Enumeration Date	:	12/11/2023
Last Update Date	:	12/11/2023

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