Provider Demographics
NPI:1811416019
Name:INTEGRATED CARE CONSULTING LLC
Entity Type:Organization
Organization Name:INTEGRATED CARE CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-389-0697
Mailing Address - Street 1:134 LIGHTHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:WARETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08758-2015
Mailing Address - Country:US
Mailing Address - Phone:732-389-0697
Mailing Address - Fax:732-389-0611
Practice Address - Street 1:615 HOPE ROAD, BLDG 5B, 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-1277
Practice Address - Country:US
Practice Address - Phone:732-389-0697
Practice Address - Fax:732-389-0611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-19
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1538285911OtherOWNER'S INDIVIDUAL NPI
NJ1760812051OtherPARTNER'S INDIVIDUAL NPI