=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841543550
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRATED-1 CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2012
-----------------------------------------------------
Last Update Date | 10/18/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2728 SE 16TH PL
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33904-3209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-573-7598
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2728 SE 16TH PL
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33904-3209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | ALEKSANDRA LEVITINA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 239-573-7598
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL10682
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------