Provider Demographics
NPI:1639331648
Name:INDIVIDUA;IZED CARE, INC.
Entity Type:Organization
Organization Name:INDIVIDUA;IZED 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:YVONNE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-369-0080
Mailing Address - Street 1:464 EASTWAY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-1402
Mailing Address - Country:US
Mailing Address - Phone:704-369-0080
Mailing Address - Fax:704-369-0084
Practice Address - Street 1:464 EASTWAY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-1402
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:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management