Organization
UNIQUE EXPRESSIONS K/R INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KEISHA RENEE GILL MAM (OWNER/QUALIFIED PROFESSIONAL)
(910) 875-1482
Entity
Organization
Contact information
Practice address
529 HARRIS AVENUE, RAEFORD, NC 28376-6505
(910) 875-1482
(910) 875-8757
Mailing address
PO BOX 26, RAEFORD, NC 28376-6505
(910) 875-1482
(910) 875-8757
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251G00000X
Community Based Hospice Care Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
251X00000X
Supports Brokerage Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
3747P1801X
Personal Care Attendant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3418078
—
NC
05
—
3418529
—
NC
01
—
8301757B
COMM SUPPORT
NC
Enumeration date
10/17/2006
Last updated
08/31/2010
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