Provider Demographics
NPI:1811753155
Name:INTEGRALIS SERVICES LLC
Entity type:Organization
Organization Name:INTEGRALIS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:SAMOT
Authorized Official - Suffix:
Authorized Official - Credentials:LIC
Authorized Official - Phone:939-717-1653
Mailing Address - Street 1:PO BOX 2537
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-9537
Mailing Address - Country:US
Mailing Address - Phone:939-323-0563
Mailing Address - Fax:
Practice Address - Street 1:121 RUTA 474
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-4023
Practice Address - Country:US
Practice Address - Phone:939-323-0563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty