Provider Demographics
NPI:1508138892
Name:UNITY SUPPORTIVE CARE MANAGEMENT, LLC
Entity Type:Organization
Organization Name:UNITY SUPPORTIVE CARE MANAGEMENT, LLC
Other - Org Name:UNITY HOSPICE AND PALLIATIVE
Other - Org Type:Other Name
Authorized Official - Title/Position:SR. DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-339-6793
Mailing Address - Street 1:2366 OAK RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-9207
Mailing Address - Country:US
Mailing Address - Phone:920-338-1111
Mailing Address - Fax:920-339-6795
Practice Address - Street 1:2366 OAK RIDGE CIR
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-9207
Practice Address - Country:US
Practice Address - Phone:920-338-1111
Practice Address - Fax:920-339-6795
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITY LIMITED PARTNERSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-01
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1503208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty