Provider Demographics
NPI:1366284317
Name:A UNIQUE IMPACT
Entity type:Organization
Organization Name:A UNIQUE IMPACT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:SHONDALYNN
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:PRICE-DONELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-409-5226
Mailing Address - Street 1:610 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-2714
Mailing Address - Country:US
Mailing Address - Phone:419-270-7901
Mailing Address - Fax:
Practice Address - Street 1:610 ADAMS ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-2714
Practice Address - Country:US
Practice Address - Phone:419-270-7901
Practice Address - Fax:419-297-0391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder