Provider Demographics
NPI:1710343629
Name:INTEGRATED SENIOR CARE PERSONAL CARE
Entity Type:Organization
Organization Name:INTEGRATED SENIOR CARE PERSONAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:435-628-8944
Mailing Address - Street 1:616 S RIVER RD
Mailing Address - Street 2:200
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-2104
Mailing Address - Country:US
Mailing Address - Phone:435-628-8944
Mailing Address - Fax:
Practice Address - Street 1:616 S RIVER RD
Practice Address - Street 2:200
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2104
Practice Address - Country:US
Practice Address - Phone:435-628-8944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTPENDINGMedicaid