Provider Demographics
NPI:1043787880
Name:UNITY FOR DEVELOPMENTAL DISABILITIES
Entity Type:Organization
Organization Name:UNITY FOR DEVELOPMENTAL DISABILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHON
Authorized Official - Middle Name:
Authorized Official - Last Name:TYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-856-4404
Mailing Address - Street 1:3847 SCHENLEY AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-6336
Mailing Address - Country:US
Mailing Address - Phone:973-856-4404
Mailing Address - Fax:
Practice Address - Street 1:2204 MORRIS AVE STE L-2
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-5918
Practice Address - Country:US
Practice Address - Phone:973-856-4404
Practice Address - Fax:973-228-3964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No347C00000XTransportation ServicesPrivate Vehicle
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child