Provider Demographics
NPI:1558790931
Name:INTEGRATED CARE MANAGEMENT SOLUTIONS
Entity Type:Organization
Organization Name:INTEGRATED CARE MANAGEMENT SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-751-9904
Mailing Address - Street 1:1547 PLUMAS CT
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-2960
Mailing Address - Country:US
Mailing Address - Phone:530-751-9904
Mailing Address - Fax:530-751-9915
Practice Address - Street 1:564 S DORA ST
Practice Address - Street 2:SUITE D
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5486
Practice Address - Country:US
Practice Address - Phone:707-472-0362
Practice Address - Fax:707-472-0121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)