Provider Demographics
NPI:1710176912
Name:INFORMED CARE SOLUTION, INC
Entity Type:Organization
Organization Name:INFORMED CARE SOLUTION, INC
Other - Org Name:INFORMED CARE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-344-3702
Mailing Address - Street 1:PO BOX 6250
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-6250
Mailing Address - Country:US
Mailing Address - Phone:772-344-3702
Mailing Address - Fax:772-344-3701
Practice Address - Street 1:325 FOUR LEAF LN
Practice Address - Street 2:SUITE 11
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-9203
Practice Address - Country:US
Practice Address - Phone:772-344-3702
Practice Address - Fax:772-344-3701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017001266363L00000X
VANP0024165998363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08459Medicare PIN