Provider Demographics
NPI:1992849517
Name:INTEGRATED COMMUNITY SERVICES
Entity Type:Organization
Organization Name:INTEGRATED COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMMON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:415-455-8481
Mailing Address - Street 1:3020 KERNER BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-5444
Mailing Address - Country:US
Mailing Address - Phone:415-455-8481
Mailing Address - Fax:415-455-8483
Practice Address - Street 1:3020 KERNER BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-5444
Practice Address - Country:US
Practice Address - Phone:415-455-8481
Practice Address - Fax:415-455-8483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40679953251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management