Provider Demographics
NPI:1942884879
Name:UNITICARE
Entity Type:Organization
Organization Name:UNITICARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOMNNIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICE-MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-369-6642
Mailing Address - Street 1:10116 MARVEL COVE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-8771
Mailing Address - Country:US
Mailing Address - Phone:702-912-8981
Mailing Address - Fax:
Practice Address - Street 1:10116 MARVEL COVE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-8771
Practice Address - Country:US
Practice Address - Phone:702-912-8981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-06
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility