Provider Demographics
NPI:1194967513
Name:UNIQUE SERVICES
Entity type:Organization
Organization Name:UNIQUE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:BRATTON
Authorized Official - Suffix:
Authorized Official - Credentials:B S HUMAN SERVICE
Authorized Official - Phone:336-473-8736
Mailing Address - Street 1:310 FORESTROSE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-2107
Mailing Address - Country:US
Mailing Address - Phone:336-473-8736
Mailing Address - Fax:336-728-4360
Practice Address - Street 1:310 FORESTROSE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-2107
Practice Address - Country:US
Practice Address - Phone:336-473-8736
Practice Address - Fax:336-728-4360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-029-112320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities