Provider Demographics
NPI:1164488334
Name:UNICARE HOME HEALTH SERVICES OF TYLER, INC.
Entity Type:Organization
Organization Name:UNICARE HOME HEALTH SERVICES OF TYLER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MINI
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-531-9949
Mailing Address - Street 1:3300 S BROADWAY AVE
Mailing Address - Street 2:STE 208
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-7818
Mailing Address - Country:US
Mailing Address - Phone:903-531-9949
Mailing Address - Fax:903-531-9951
Practice Address - Street 1:3300 S BROADWAY AVE
Practice Address - Street 2:STE 208
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-7818
Practice Address - Country:US
Practice Address - Phone:903-531-9949
Practice Address - Fax:903-531-9951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX006918251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX024406301Medicaid