Provider Demographics
NPI:1649600289
Name:UNI
Entity Type:Organization
Organization Name:UNI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:THARAKAN
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:516-993-7775
Mailing Address - Street 1:1711 HORIZON HEIGHTS CIR
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-1159
Mailing Address - Country:US
Mailing Address - Phone:516-993-7775
Mailing Address - Fax:
Practice Address - Street 1:1711 HORIZON HEIGHTS CIR
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-1159
Practice Address - Country:US
Practice Address - Phone:516-993-7775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA798212310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness