Provider Demographics
NPI:1063004422
Name:INTEGRATED ENRICHMENT INCORPORATED
Entity Type:Organization
Organization Name:INTEGRATED ENRICHMENT INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:O'NELIUS
Authorized Official - Last Name:SLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-709-8317
Mailing Address - Street 1:328 WYATTS RD
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND
Mailing Address - State:VA
Mailing Address - Zip Code:24569-2642
Mailing Address - Country:US
Mailing Address - Phone:434-709-8317
Mailing Address - Fax:
Practice Address - Street 1:328 WYATTS RD
Practice Address - Street 2:
Practice Address - City:LONG ISLAND
Practice Address - State:VA
Practice Address - Zip Code:24569-2642
Practice Address - Country:US
Practice Address - Phone:434-709-8317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty