MEDICARE: UNIQUELY SUPPORTED

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689710162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIQUELY SUPPORTED

Provider Business Mailing Address
First Line	:	PO BOX 690
Second Line	:
City	:	FALLSTON
State	:	NC
Zip	:	28042-0690
Country	:	US
Telephone Number	:	704-538-3648
Fax Number	:	704-538-6940

Provider Business Practice Location Address
First Line	:	2904 PHILADELPHIA RD
Second Line	:
City	:	LAWNDALE
State	:	NC
Zip	:	28090-9461
Country	:	US
Telephone Number	:	704-538-3648
Fax Number	:

Authorized Official
Title or Position	:	ADMINSTRATOR
Name	:	MS. DANA HEAD
Credential	:
Telephone Number	:	828-289-4333

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	08/22/2020

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Directions to “UNIQUELY SUPPORTED ” Practice Location

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