Provider Demographics
NPI:1437298833
Name:INTEGRATED CARE CORP, INC.
Entity Type:Organization
Organization Name:INTEGRATED CARE CORP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:PANICHELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-593-7447
Mailing Address - Street 1:371 BETHEL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-2074
Mailing Address - Country:US
Mailing Address - Phone:724-593-7447
Mailing Address - Fax:724-593-7448
Practice Address - Street 1:371 BETHEL CHURCH RD
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-2074
Practice Address - Country:US
Practice Address - Phone:724-593-7447
Practice Address - Fax:724-593-7448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1000040110013171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1000040110013Medicaid