Basic Information
| Provider Information | |||||||||
| NPI: | 1407399090 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRATED HEALTHCARE ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 132 | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457010132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003218293 | ||||||||
| FaxNumber: | 8446237178 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 CHARLES ST | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457012329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003218293 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2016 | ||||||||
| LastUpdateDate: | 11/30/2016 | ||||||||
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| AuthorizedOfficialLastName: | WILSON | ||||||||
| AuthorizedOfficialFirstName: | JACLYN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PROJECT MANAGER - BILLING | ||||||||
| AuthorizedOfficialTelephone: | 7402586480 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | INTEGRATED SERVICES FOR BEHAVIORAL HEALTH | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN.CNP.019584 | OH | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.