Provider Demographics
NPI:1154402303
Name:UNIQUE EXPRESSIONS K/R INC
Entity type:Organization
Organization Name:UNIQUE EXPRESSIONS K/R INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/QUALIFIED PROFESSIONAL
Authorized Official - Prefix:MS
Authorized Official - First Name:KEISHA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:MAM
Authorized Official - Phone:910-875-1482
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-6505
Mailing Address - Country:US
Mailing Address - Phone:910-875-1482
Mailing Address - Fax:910-875-8757
Practice Address - Street 1:529 HARRIS AVENUE
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-6505
Practice Address - Country:US
Practice Address - Phone:910-875-1482
Practice Address - Fax:910-875-8757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
No251G00000XAgenciesHospice Care, Community Based
No251S00000XAgenciesCommunity/Behavioral Health
No251X00000XAgenciesSupports Brokerage
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Multi-Specialty
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed ChildrenGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418078Medicaid
NC3418529Medicaid
NC8301757BOtherCOMM SUPPORT