Provider Demographics
NPI:1326406067
Name:UNITED COMMUNITY CORP
Entity Type:Organization
Organization Name:UNITED COMMUNITY CORP
Other - Org Name:UNITED PERSONAL SUPPORTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-351-8410
Mailing Address - Street 1:6450 W ATLANTIC BLVD
Mailing Address - Street 2:STE #4
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-4532
Mailing Address - Country:US
Mailing Address - Phone:786-351-8410
Mailing Address - Fax:
Practice Address - Street 1:6450 W ATLANTIC BLVD
Practice Address - Street 2:STE #4
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-4532
Practice Address - Country:US
Practice Address - Phone:786-351-8410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL234195251C00000X, 253Z00000X
251E00000X, 253Z00000X, 372600000X, 373H00000X, 3747A0650X, 3747P1801X, 374U00000X, 376J00000X, 385H00000X, 385HR2060X, 385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, ChildGroup - Single Specialty
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016908500Medicaid
FL016908500OtherAGENCY FOR PERSONS WITH DISABILITIES
FL234195OtherAGENCY FOR HEALTHCARE ADMINISTRATION LICENSE NUMBER