Provider Demographics
NPI:1740806108
Name:UNIQUE INTEGRATED CARE, LLC
Entity Type:Organization
Organization Name:UNIQUE INTEGRATED CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:UZMA
Authorized Official - Last Name:HASAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-462-0142
Mailing Address - Street 1:PO BOX 13334
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-0056
Mailing Address - Country:US
Mailing Address - Phone:480-776-9513
Mailing Address - Fax:866-682-6631
Practice Address - Street 1:2000 E SOUTHERN AVE STE 102&104
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7510
Practice Address - Country:US
Practice Address - Phone:480-462-0142
Practice Address - Fax:866-682-6631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-22
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOTC10251Medicaid