Provider Demographics
NPI:1447379284
Name:INCA COMMNITY SERVICES, INC.
Entity Type:Organization
Organization Name:INCA COMMNITY SERVICES, INC.
Other - Org Name:INCA CAREER OPPORTUNITIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-889-7393
Mailing Address - Street 1:PO BOX 807
Mailing Address - Street 2:301 WEST 10TH STREET
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-0807
Mailing Address - Country:US
Mailing Address - Phone:580-889-7393
Mailing Address - Fax:580-889-7393
Practice Address - Street 1:301 W 10TH ST
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-2800
Practice Address - Country:US
Practice Address - Phone:580-889-7393
Practice Address - Fax:580-889-7393
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INCA COMMUNITY SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-29
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100680650FMedicaid
OK100680650GMedicaid
OK100680650BMedicaid
OK100680650DMedicaid
OK100680650AMedicaid
OK100680650HMedicaid
OK100680650CMedicaid
OK100680650EMedicaid