Healthcare Provider Details

I. General information

NPI: 1407244304
Provider Name (Legal Business Name): INTEGRATED COMMUNITY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6323 GEORGIA AVE NW STE 350
WASHINGTON DC
20011-1151
US

IV. Provider business mailing address

6323 GEORGIA AVE NW STE 350
WASHINGTON DC
20011-1151
US

V. Phone/Fax

Practice location:
  • Phone: 202-506-1209
  • Fax: 301-434-3583
Mailing address:
  • Phone: 202-506-1209
  • Fax: 301-434-3583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. ROSE OMA
Title or Position: CEO
Credential: AUD
Phone: 301-434-3503