Provider Demographics
NPI:1932959798
Name:UNLIMITED POTENTIAL, INC.
Entity Type:Organization
Organization Name:UNLIMITED POTENTIAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:NELLY
Authorized Official - Last Name:VIERA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MPH
Authorized Official - Phone:602-615-0994
Mailing Address - Street 1:PO BOX 8814
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85066-8814
Mailing Address - Country:US
Mailing Address - Phone:602-305-4742
Mailing Address - Fax:
Practice Address - Street 1:3146 E WIER AVE RM 34
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-2754
Practice Address - Country:US
Practice Address - Phone:602-305-4742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty