Provider Demographics
NPI:1255620951
Name:INTEGRATED HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:INTEGRATED HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BALOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-838-1894
Mailing Address - Street 1:2 EATON ST STE 1103
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-4054
Mailing Address - Country:US
Mailing Address - Phone:757-838-1894
Mailing Address - Fax:
Practice Address - Street 1:2 EATON ST STE 1103
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-4054
Practice Address - Country:US
Practice Address - Phone:757-838-1894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1255620951Medicaid