Provider Demographics
NPI:1548768732
Name:UNICORN GARDEN, INC.
Entity Type:Organization
Organization Name:UNICORN GARDEN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDNALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-301-1479
Mailing Address - Street 1:3817 EDITH LN
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304-6703
Mailing Address - Country:US
Mailing Address - Phone:661-834-7789
Mailing Address - Fax:661-834-2340
Practice Address - Street 1:3817 EDITH LN
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-6703
Practice Address - Country:US
Practice Address - Phone:661-834-7789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA150406795322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children