Provider Demographics
NPI:1417248634
Name:INTEGRITAS LTC OF MISSISSIPPI
Entity Type:Organization
Organization Name:INTEGRITAS LTC OF MISSISSIPPI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE AND OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YOFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-568-7896
Mailing Address - Street 1:12201 BLUEGRASS PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2361
Mailing Address - Country:US
Mailing Address - Phone:502-568-7896
Mailing Address - Fax:502-568-7136
Practice Address - Street 1:12201 BLUEGRASS PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-2361
Practice Address - Country:US
Practice Address - Phone:502-568-7896
Practice Address - Fax:502-568-7136
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRITAS PROFESSIONAL DEVELOPMENT SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-21
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty