Healthcare Provider Details

I. General information

NPI: 1710343629
Provider Name (Legal Business Name): INTEGRATED SENIOR CARE PERSONAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 S RIVER RD 200
ST GEORGE UT
84790-2104
US

IV. Provider business mailing address

616 S RIVER RD 200
ST GEORGE UT
84790-2104
US

V. Phone/Fax

Practice location:
  • Phone: 435-628-8944
  • Fax:
Mailing address:
  • Phone: 435-628-8944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierPENDING
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer

VIII. Authorized Official

Name: MR. MARK L PHILLIPS
Title or Position: PRESIDENT
Credential: CEO
Phone: 435-628-8944