Provider Demographics
NPI:1679705958
Name:INTENSIVE MENTAL CARE INC
Entity Type:Organization
Organization Name:INTENSIVE MENTAL CARE INC
Other - Org Name:INTENSIVE REHAB- HEALTH SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:COSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-426-1390
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:WINFALL
Mailing Address - State:NC
Mailing Address - Zip Code:27985-0130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 WEST MAPEL STREET
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:27938
Practice Address - Country:US
Practice Address - Phone:252-426-1390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health