Provider Demographics
NPI:1386199362
Name:UNIQUE ADVANCED CARE SUPPORT SERVICE LLC
Entity type:Organization
Organization Name:UNIQUE ADVANCED CARE SUPPORT SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOMONIQUE
Authorized Official - Middle Name:N
Authorized Official - Last Name:FASHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-818-2814
Mailing Address - Street 1:1408 LONGVILLE CIR
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-4918
Mailing Address - Country:US
Mailing Address - Phone:352-818-2814
Mailing Address - Fax:
Practice Address - Street 1:1408 LONGVILLE CIR
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4918
Practice Address - Country:US
Practice Address - Phone:352-818-2814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care