Provider Demographics
NPI:1689159980
Name:INTEGRATED CARE RESOURCES OF GEORGIA, LLC
Entity Type:Organization
Organization Name:INTEGRATED CARE RESOURCES OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, LCSW
Authorized Official - Phone:770-875-5504
Mailing Address - Street 1:7794 FLYAWAY RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-3511
Mailing Address - Country:US
Mailing Address - Phone:770-875-5504
Mailing Address - Fax:866-260-5504
Practice Address - Street 1:2011 COMMERCE DR N
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3538
Practice Address - Country:US
Practice Address - Phone:470-483-6929
Practice Address - Fax:866-260-5504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-02
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility