Healthcare Provider Details

I. General information

NPI: 1558358846
Provider Name (Legal Business Name): INTEGRATED CARE SYSTEMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2005
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 TRANSIT RD
NEWFANE NY
14108-9701
US

IV. Provider business mailing address

2709 TRANSIT RD
NEWFANE NY
14108-9701
US

V. Phone/Fax

Practice location:
  • Phone: 716-778-7111
  • Fax: 716-778-9218
Mailing address:
  • Phone: 716-778-7111
  • Fax: 716-778-9218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3154302N
License Number StateNY

VIII. Authorized Official

Name: MR. DONALD L KEPNER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 716-514-5527