Provider Demographics
NPI:1871724880
Name:UNITED COMMUNITY INDEPENDENCE PROGRAMS
Entity type:Organization
Organization Name:UNITED COMMUNITY INDEPENDENCE PROGRAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FISCAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-336-4157
Mailing Address - Street 1:17999 CUSSEWAGO RD
Mailing Address - Street 2:PO BOX 437
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-6254
Mailing Address - Country:US
Mailing Address - Phone:814-336-4157
Mailing Address - Fax:814-336-4178
Practice Address - Street 1:2709 SAWMILL RD
Practice Address - Street 2:
Practice Address - City:LUCINDA
Practice Address - State:PA
Practice Address - Zip Code:16235-4623
Practice Address - Country:US
Practice Address - Phone:814-336-4157
Practice Address - Fax:814-336-4178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities