Provider Demographics
NPI:1235521774
Name:INTELLICARE SERVICES LLC
Entity Type:Organization
Organization Name:INTELLICARE SERVICES LLC
Other - Org Name:INTELLICARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIZON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:209-406-0817
Mailing Address - Street 1:1630 N EDISON ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5633
Mailing Address - Country:US
Mailing Address - Phone:209-406-0817
Mailing Address - Fax:209-451-4997
Practice Address - Street 1:10410 RUDDER WAY
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-4348
Practice Address - Country:US
Practice Address - Phone:209-406-0817
Practice Address - Fax:209-451-4997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management