MEDICARE: UNICE SUPPORTIVE HOUSING INC

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	253J00000X	Foster Care Agency

General Provider Information

NPI Number	:	1699163261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNICE SUPPORTIVE HOUSING INC

Provider Business Mailing Address
First Line	:	38 FOREST PARK AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01108-1606
Country	:	US
Telephone Number	:	413-328-0027
Fax Number	:

Provider Business Practice Location Address
First Line	:	38 FOREST PARK AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01108-1606
Country	:	US
Telephone Number	:	413-328-0027
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	OKEY IKEWIBE
Credential	:
Telephone Number	:	413-328-0027

Provider Enumeration Date	:	01/05/2015
Last Update Date	:	01/05/2015

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Directions to “UNICE SUPPORTIVE HOUSING INC ” Practice Location

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