Provider Demographics
NPI:1043622137
Name:INTEGRATED CARE MANAGEMENT SOLUTIONS
Entity Type:Organization
Organization Name:INTEGRATED CARE MANAGEMENT SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-751-9904
Mailing Address - Street 1:1547 PLUMAS CT
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-2960
Mailing Address - Country:US
Mailing Address - Phone:530-751-9917
Mailing Address - Fax:530-751-9915
Practice Address - Street 1:544 S MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-5107
Practice Address - Country:US
Practice Address - Phone:707-961-0172
Practice Address - Fax:707-961-0127
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATED CARE MANAGEMENT SOLUTIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-23
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)