Provider Demographics
NPI:1659694644
Name:UNIVERSAL SERVICE AND MORE, LLC
Entity Type:Organization
Organization Name:UNIVERSAL SERVICE AND MORE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LUE
Authorized Official - Middle Name:VAILLE
Authorized Official - Last Name:HOLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MPA, MHA, MHSA
Authorized Official - Phone:219-796-7764
Mailing Address - Street 1:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:GRIFFITH
Mailing Address - State:IN
Mailing Address - Zip Code:46319-0296
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:487 BROADWAY
Practice Address - Street 2:SUITE 109
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46402-1231
Practice Address - Country:US
Practice Address - Phone:219-796-7764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN90070201332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200962330AOtherLPI