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General NPI Number Information
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NPI Number | 1275249286
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE CARE LLC
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Dates
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Enumeration Date | 01/24/2023
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 1912 LIBERTY RD STE K
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City | ELDERSBURG
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State | MD
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Zip | 21784-6602
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Country | US
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Telephone | 347-581-9436
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Fax |
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Provider Business Mailing Address
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Address Line | 1912 LIBERTY RD STE K
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City | ELDERSBURG
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State | MD
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Zip | 21784-6602
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Country | US
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Telephone | 443-525-1465
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OPERATIONS
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Name | MR. CURTIS LEWIS JR.
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Credential |
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Telephone | 903-651-6999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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