Provider Demographics
NPI:1568107795
Name:UNIFIED HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:UNIFIED HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FUNSO
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUNLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-384-8820
Mailing Address - Street 1:4250 N 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-5108
Mailing Address - Country:US
Mailing Address - Phone:602-384-8820
Mailing Address - Fax:
Practice Address - Street 1:9014 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-8304
Practice Address - Country:US
Practice Address - Phone:602-384-8820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2023-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)