Provider Demographics
NPI:1083081525
Name:UNIVEST, LLC
Entity Type:Organization
Organization Name:UNIVEST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOLERY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:785-217-5999
Mailing Address - Street 1:23200 CRAFTSMAN DR
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-4811
Mailing Address - Country:US
Mailing Address - Phone:785-217-5999
Mailing Address - Fax:
Practice Address - Street 1:1300 E 24TH ST
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-8233
Practice Address - Country:US
Practice Address - Phone:660-827-3313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
MO043278313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility