Provider Demographics
NPI:1144747692
Name:UOM, INC
Entity Type:Organization
Organization Name:UOM, INC
Other - Org Name:UOM, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:COWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-399-0418
Mailing Address - Street 1:3615 VICTORY BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-3419
Mailing Address - Country:US
Mailing Address - Phone:757-399-0418
Mailing Address - Fax:757-337-4274
Practice Address - Street 1:3615 VICTORY BLVD STE 105
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-3419
Practice Address - Country:US
Practice Address - Phone:757-399-0418
Practice Address - Fax:757-337-4274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-25
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1144747692Medicaid