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General NPI Number Information
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NPI Number | 1992849517
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Entity Type | Organization
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Legal Business Name | INTEGRATED COMMUNITY SERVICES
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3020 KERNER BLVD SUITE A
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City | SAN RAFAEL
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State | CA
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Zip | 94901-5444
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Country | US
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Telephone | 415-455-8481
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Fax | 415-455-8483
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Provider Business Mailing Address
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Address Line | 3020 KERNER BLVD SUITE A
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City | SAN RAFAEL
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State | CA
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Zip | 94901-5444
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Country | US
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Telephone | 415-455-8481
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Fax | 415-455-8483
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DONNA LEMMON
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Credential | M.S.
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Telephone | 415-455-8481
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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 | 40679953
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License Number State | CA
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