Provider Demographics
NPI:1790950087
Name:INFORMED CARE SOLUTIONS, INC.
Entity Type:Organization
Organization Name:INFORMED CARE SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CONSOLATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-800-4882
Mailing Address - Street 1:801 DOUGLAS AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-5206
Mailing Address - Country:US
Mailing Address - Phone:877-800-4882
Mailing Address - Fax:
Practice Address - Street 1:2608 QUEEN MARGARET DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056-5805
Practice Address - Country:US
Practice Address - Phone:877-800-4882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX750872363L00000X
TX582114363LF0000X
TX0001154175363LF0000X
TX774901363LF0000X
TX226308363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF4458OtherRR MEDICARE
TX0053NLOtherBLUE CROSS BLUE SHIELD
TX180957601Medicaid
DF4458OtherRR MEDICARE