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General NPI Number Information
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NPI Number | 1306781158
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Entity Type | Organization
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Legal Business Name | INTEGRATED CARE SUPPORT SVCS NC
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Dates
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Enumeration Date | 04/20/2026
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Last Update Date | 04/20/2026
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Provider Practice Location Address
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Address Line | 96031 BROADMOOR RD
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034
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Country | US
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Telephone | 704-929-8119
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Fax |
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Provider Business Mailing Address
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Address Line | 96031 BROADMOOR RD
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034
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Country | US
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Telephone | 704-929-8119
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Fax |
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Authorized Official
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Title or Position | QUALIFIED PROFESSIONAL/CASE MANAGER
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Name | KRISTY PAVELOCK
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Credential | B.A.
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Telephone | 704-929-8119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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