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General NPI Number Information
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NPI Number | 1265072078
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Entity Type | Organization
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Legal Business Name | INTEGRATED COMMUNITY SUPPORT, LLC
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Dates
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Enumeration Date | 01/09/2020
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Last Update Date | 11/12/2021
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Provider Practice Location Address
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Address Line | 13643 SW 26TH ST
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City | MIAMI
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State | FL
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Zip | 33175-6378
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Country | US
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Telephone | 305-400-8281
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Fax | 305-400-8513
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Provider Business Mailing Address
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Address Line | 13643 SW 26TH ST
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City | MIAMI
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State | FL
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Zip | 33175-6378
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Country | US
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Telephone | 305-400-8281
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Fax | 305-400-8513
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Authorized Official
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Title or Position | PRESIDENT
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Name | JULIO RODRIGUEZ
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Credential |
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Telephone | 786-818-5289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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