Provider Demographics
NPI:1417696402
Name:UNIQUE SENIOR CONCIERGE SERVICES LLC
Entity Type:Organization
Organization Name:UNIQUE SENIOR CONCIERGE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWAYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-709-2318
Mailing Address - Street 1:4031 NORTHRIDGE WAY APT 5
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-3064
Mailing Address - Country:US
Mailing Address - Phone:770-709-2318
Mailing Address - Fax:
Practice Address - Street 1:4031 NORTHRIDGE WAY APT 5
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3064
Practice Address - Country:US
Practice Address - Phone:770-709-2318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)