MEDICARE: A UNIQUE FAMILY HOME 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1871279877
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A UNIQUE FAMILY HOME LLC

Provider Business Mailing Address
First Line	:	313 LAKEWOOD DR
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75115-3905
Country	:	US
Telephone Number	:	214-546-7974
Fax Number	:

Provider Business Practice Location Address
First Line	:	313 LAKEWOOD DR
Second Line	:
City	:	DESOTO
State	:	TX
Zip	:	75115-3905
Country	:	US
Telephone Number	:	214-546-7974
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KECIA ABRAM
Credential	:	REGISTERED NURSE
Telephone Number	:	214-546-7974

Provider Enumeration Date	:	06/26/2023
Last Update Date	:	06/26/2023

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Directions to “A UNIQUE FAMILY HOME LLC ” Practice Location

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