Healthcare Provider Details

I. General information

NPI: 1629913389
Provider Name (Legal Business Name): INTEGRATIVE HUMAN SERVICE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 DANZLER CIR
NORTH CHESTERFIELD VA
23224-4311
US

IV. Provider business mailing address

3121 DANZLER CIR
NORTH CHESTERFIELD VA
23224-4311
US

V. Phone/Fax

Practice location:
  • Phone: 443-529-4960
  • Fax:
Mailing address:
  • Phone: 443-529-4960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State

VIII. Authorized Official

Name: OLAJUMOKE ORIYOMI OGUNTOLA
Title or Position: ADMINISTRATOR
Credential:
Phone: 443-529-4960