Provider Demographics
NPI:1689373136
Name:UNIQUE 403 LLC
Entity Type:Organization
Organization Name:UNIQUE 403 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEGETTE
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:470-871-4840
Mailing Address - Street 1:PO BOX 961
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-0961
Mailing Address - Country:US
Mailing Address - Phone:678-614-5444
Mailing Address - Fax:
Practice Address - Street 1:5303 WALKER CT SW
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-2207
Practice Address - Country:US
Practice Address - Phone:470-871-4840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health