Healthcare Provider Details

I. General information

NPI: 1023481249
Provider Name (Legal Business Name): INTEGRATED COMMUNITY HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 11/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 MARTIN LUTHER KING JR DR STE A
GREENSBORO NC
27406-3300
US

IV. Provider business mailing address

6604 BARTON CREEK DR
WHITSETT NC
27377-9277
US

V. Phone/Fax

Practice location:
  • Phone: 336-271-5888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CARL NOYES
Title or Position: CCO
Credential:
Phone: 919-223-4571