Provider Demographics
NPI:1336478023
Name:UNIQUE MANOR AND REHAB LLC
Entity Type:Organization
Organization Name:UNIQUE MANOR AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-894-3298
Mailing Address - Street 1:1123 DEEP RIVER DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-6247
Mailing Address - Country:US
Mailing Address - Phone:832-260-3763
Mailing Address - Fax:
Practice Address - Street 1:1123 DEEP RIVER DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-6247
Practice Address - Country:US
Practice Address - Phone:832-260-3763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 253J00000X
TX320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253J00000XAgenciesFoster Care Agency