Provider Demographics
NPI:1740400589
Name:INTEGRA HEALTH MANAGEMENT
Entity Type:Organization
Organization Name:INTEGRA HEALTH MANAGEMENT
Other - Org Name:SC CARE MANAGEMENT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:BOBBI
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:GITTERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-581-3030
Mailing Address - Street 1:10711 RED RUN BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5138
Mailing Address - Country:US
Mailing Address - Phone:410-581-3030
Mailing Address - Fax:410-581-2018
Practice Address - Street 1:10711 RED RUN BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5138
Practice Address - Country:US
Practice Address - Phone:410-581-3030
Practice Address - Fax:410-581-2018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR1159251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management