Healthcare Provider Details

I. General information

NPI: 1881410645
Provider Name (Legal Business Name): INTEGRATED COMMUNITY OUTREACH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9630 HADLEIGH CT
LAUREL MD
20723-5932
US

IV. Provider business mailing address

PO BOX 56
SAVAGE MD
20763-0056
US

V. Phone/Fax

Practice location:
  • Phone: 202-651-0214
  • Fax:
Mailing address:
  • Phone: 202-651-0214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. MICHAEL ALLEN
Title or Position: CEO
Credential:
Phone: 202-651-0214