Provider Demographics
NPI:1588755201
Name:UNITY HOME HEALTH AGENCY & MEDICAL SUPPLY
Entity type:Organization
Organization Name:UNITY HOME HEALTH AGENCY & MEDICAL SUPPLY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDNIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-687-1669
Mailing Address - Street 1:11671 STERLING AVE
Mailing Address - Street 2:# A
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-4971
Mailing Address - Country:US
Mailing Address - Phone:951-687-1669
Mailing Address - Fax:
Practice Address - Street 1:11671 STERLING AVE
Practice Address - Street 2:# A
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-4971
Practice Address - Country:US
Practice Address - Phone:951-687-1669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48440332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5156200001Medicare NSC