Provider Demographics
NPI:1689204166
Name:THERAPEUTIC INTEGRATED MEDICAL CARE INC
Entity Type:Organization
Organization Name:THERAPEUTIC INTEGRATED MEDICAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GENEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-617-6313
Mailing Address - Street 1:PO BOX 71526
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89170-1526
Mailing Address - Country:US
Mailing Address - Phone:702-617-6313
Mailing Address - Fax:702-901-7224
Practice Address - Street 1:916 W OWENS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2516
Practice Address - Country:US
Practice Address - Phone:702-617-6313
Practice Address - Fax:702-901-7224
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THERAPEUTIC INTEGRATED MEDICAL CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty