Provider Demographics
NPI:1609389295
Name:UNCONDITIONAL CARE & SUPPORTIVE SERVICES, INC
Entity Type:Organization
Organization Name:UNCONDITIONAL CARE & SUPPORTIVE SERVICES, INC
Other - Org Name:UCASS, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CORNELL
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-852-8437
Mailing Address - Street 1:1500 PORTER ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-2068
Mailing Address - Country:US
Mailing Address - Phone:804-852-8437
Mailing Address - Fax:757-977-1787
Practice Address - Street 1:909 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-3002
Practice Address - Country:US
Practice Address - Phone:804-852-8437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3104Medicaid