Provider Demographics
NPI:1447602040
Name:INTEGRATED SOLUTION LLC
Entity Type:Organization
Organization Name:INTEGRATED SOLUTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRIEWETHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-846-6759
Mailing Address - Street 1:18441 SUSSEX
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235
Mailing Address - Country:US
Mailing Address - Phone:586-846-6759
Mailing Address - Fax:
Practice Address - Street 1:24791 PARKSIDE ST.
Practice Address - Street 2:APT. 206
Practice Address - City:HARRISON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48045
Practice Address - Country:US
Practice Address - Phone:586-846-6759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-07
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801085567104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty