Provider Demographics
NPI:1295416048
Name:UNITED SERVICE GROUP, LLC
Entity type:Organization
Organization Name:UNITED SERVICE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:KARINA
Authorized Official - Last Name:PINEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-696-8960
Mailing Address - Street 1:3226 S SARIVAL AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-3505
Mailing Address - Country:US
Mailing Address - Phone:623-696-8960
Mailing Address - Fax:
Practice Address - Street 1:3226 S SARIVAL AVE
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-3505
Practice Address - Country:US
Practice Address - Phone:623-696-8960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253J00000XAgenciesFoster Care Agency
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, ChildGroup - Multi-Specialty