Provider Demographics
NPI:1659145217
Name:INTEGRATED COMMUNITES UNITED, LNC.
Entity Type:Organization
Organization Name:INTEGRATED COMMUNITES UNITED, LNC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOMBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-639-1206
Mailing Address - Street 1:193 GLENSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-8165
Mailing Address - Country:US
Mailing Address - Phone:931-639-1206
Mailing Address - Fax:636-754-0654
Practice Address - Street 1:193 GLENSHIRE LN
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-8165
Practice Address - Country:US
Practice Address - Phone:931-639-1206
Practice Address - Fax:636-754-0654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services