Provider Demographics
NPI:1972785137
Name:INTEGRATED RESOURCES, INC.
Entity Type:Organization
Organization Name:INTEGRATED RESOURCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EARL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-294-5610
Mailing Address - Street 1:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:MABEN
Mailing Address - State:WV
Mailing Address - Zip Code:25870-0002
Mailing Address - Country:US
Mailing Address - Phone:304-294-5610
Mailing Address - Fax:304-294-5617
Practice Address - Street 1:ROUTE 54
Practice Address - Street 2:
Practice Address - City:MABEN
Practice Address - State:WV
Practice Address - Zip Code:25870-0002
Practice Address - Country:US
Practice Address - Phone:304-294-5610
Practice Address - Fax:304-294-5617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV276251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0005343000Medicaid