Provider Demographics
NPI:1982245403
Name:UNIQUE AFFINITY DYNAMICS, LLC
Entity Type:Organization
Organization Name:UNIQUE AFFINITY DYNAMICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHELSAE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-929-8702
Mailing Address - Street 1:8005 COUNTY ROAD E45
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:IA
Mailing Address - Zip Code:52362-7514
Mailing Address - Country:US
Mailing Address - Phone:319-929-8702
Mailing Address - Fax:
Practice Address - Street 1:8005 COUNTY ROAD E45
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:IA
Practice Address - Zip Code:52362-7514
Practice Address - Country:US
Practice Address - Phone:319-929-8702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA480CC0877OtherDRIVERS LICENSE NUMBER