Basic Information
| Provider Information | |||||||||
| NPI: | 1891345211 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNITY REM, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11180 | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852840020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174428436 | ||||||||
| FaxNumber: | 4803392409 | ||||||||
| Practice Location | |||||||||
| Address1: | 4765 S LAKESHORE DR | ||||||||
| Address2: | |||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852827197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9496830014 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2019 | ||||||||
| LastUpdateDate: | 01/23/2020 | ||||||||
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| AuthorizedOfficialLastName: | CRIST | ||||||||
| AuthorizedOfficialFirstName: | NICHOLAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED AGENT | ||||||||
| AuthorizedOfficialTelephone: | 3174428436 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.