MEDICARE: INTEGRA HEALTH MANAGEMENT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency	R1159	MD

General Provider Information

NPI Number	:	1740400589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRA HEALTH MANAGEMENT

Provider Business Mailing Address
First Line	:	10711 RED RUN BLVD
Second Line	:	SUITE 112
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-5138
Country	:	US
Telephone Number	:	410-581-3030
Fax Number	:	410-581-2018

Provider Business Practice Location Address
First Line	:	10711 RED RUN BLVD
Second Line	:	SUITE 112
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-5138
Country	:	US
Telephone Number	:	410-581-3030
Fax Number	:	410-581-2018

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MS. BOBBI CAROL GITTERE
Credential	:
Telephone Number	:	410-581-3030

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	02/25/2008

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Directions to “INTEGRA HEALTH MANAGEMENT ” Practice Location

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