# UNICORN SUPPORTIVE SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710400106
- **Authorized official:** MONDAY J GABRIEL (ADMINISTRATOR)
- **Authorized official phone:** (856) 278-5188

## Contact information

- **Practice address:** 22 VALLEY FORGE DR, SWEDESBORO, NJ 08085-4230
- **Practice address phone:** (856) 278-5188
- **Mailing address:** 22 VALLEY FORGE DR, SWEDESBORO, NJ 08085-4230

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3104A0630X | Assisted Living Facility (Behavioral Disturbances) | — | NJ | — |
| 311Z00000X | Custodial Care Facility | — | NJ | — |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NJ | Yes |
| 320700000X | Physical Disabilities Residential Treatment Facility | — | NJ | — |
| 320900000X | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | — | NJ | — |

## Other

- **Enumeration date:** 07/18/2017
- **Last updated:** 07/21/2017