Provider Demographics
NPI:1629373741
Name:INTEGRATED CARE COMMUNITIES, INC.
Entity Type:Organization
Organization Name:INTEGRATED CARE COMMUNITIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:C
Authorized Official - Last Name:SAUCEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:951-243-3837
Mailing Address - Street 1:11751 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-6316
Mailing Address - Country:US
Mailing Address - Phone:951-243-3837
Mailing Address - Fax:951-485-2642
Practice Address - Street 1:11751 DAVIS ST
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-6316
Practice Address - Country:US
Practice Address - Phone:951-243-3837
Practice Address - Fax:951-485-2642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health