Provider Demographics
NPI:1629239546
Name:INDIVIDUALIZED CARE INC
Entity Type:Organization
Organization Name:INDIVIDUALIZED CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:DJARRIS
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-369-0080
Mailing Address - Street 1:543 COX RD
Mailing Address - Street 2:SUITE E - 4
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0607
Mailing Address - Country:US
Mailing Address - Phone:704-369-0080
Mailing Address - Fax:704-369-0084
Practice Address - Street 1:543 COX RD
Practice Address - Street 2:SUITE E - 4
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0607
Practice Address - Country:US
Practice Address - Phone:704-369-0080
Practice Address - Fax:704-369-0084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251B00000X251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management