Provider Demographics
NPI:1922494103
Name:UNIQUE PLUS HOME CARE AGENCY
Entity Type:Organization
Organization Name:UNIQUE PLUS HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TEARA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-483-7199
Mailing Address - Street 1:2504 RAEFORD RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5294
Mailing Address - Country:US
Mailing Address - Phone:910-483-7199
Mailing Address - Fax:910-401-1265
Practice Address - Street 1:2504 RAEFORD RD
Practice Address - Street 2:SUITE 205
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5294
Practice Address - Country:US
Practice Address - Phone:910-483-7199
Practice Address - Fax:910-401-1265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3195253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC66601888Medicaid