Provider Demographics
NPI:1477977635
Name:INTEGRATIVE TREATMENT CENTER LLC
Entity Type:Organization
Organization Name:INTEGRATIVE TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PANCIONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-903-5144
Mailing Address - Street 1:13707 ISHNALA CIR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-7804
Mailing Address - Country:US
Mailing Address - Phone:540-903-5144
Mailing Address - Fax:
Practice Address - Street 1:13707 ISHNALA CIR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-7804
Practice Address - Country:US
Practice Address - Phone:540-903-5144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-09
Last Update Date:2014-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility