Provider Demographics
NPI:1407244304
Name:INTEGRATED COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:INTEGRATED COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:OMA
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:301-434-3503
Mailing Address - Street 1:6323 GEORGIA AVE NW STE 350
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-1151
Mailing Address - Country:US
Mailing Address - Phone:202-506-1209
Mailing Address - Fax:301-434-3583
Practice Address - Street 1:6323 GEORGIA AVE NW STE 350
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-1151
Practice Address - Country:US
Practice Address - Phone:202-506-1209
Practice Address - Fax:301-434-3583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC034494100Medicaid