Provider Demographics
NPI:1780950022
Name:UNIVERSAL COMPANION CARE SERVICES
Entity type:Organization
Organization Name:UNIVERSAL COMPANION CARE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEWEL
Authorized Official - Middle Name:LUMAURE
Authorized Official - Last Name:WIGGLESWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-479-6080
Mailing Address - Street 1:106 WELLINGTON LAKES DR APT 31
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-2132
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:106 WELLINGTON LAKES DR. APT. 31
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-9524
Practice Address - Country:US
Practice Address - Phone:540-479-6080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA45-492672171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty