Provider Demographics
NPI:1841543550
Name:INTEGRATED-1 CORP
Entity type:Organization
Organization Name:INTEGRATED-1 CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVITINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-573-7598
Mailing Address - Street 1:2728 SE 16TH PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-3209
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2728 SE 16TH PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-3209
Practice Address - Country:US
Practice Address - Phone:239-573-7598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10682310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL692486701Medicaid
FL142931100Medicaid
FL692486700Medicaid