Provider Demographics
NPI:1881959062
Name:INTEGRATED CARE RESOURCES, INC.
Entity type:Organization
Organization Name:INTEGRATED CARE RESOURCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, PMHNP
Authorized Official - Phone:615-824-7780
Mailing Address - Street 1:394 W MAIN ST
Mailing Address - Street 2:SUITE A21
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3348
Mailing Address - Country:US
Mailing Address - Phone:615-824-7780
Mailing Address - Fax:615-827-0008
Practice Address - Street 1:394 W MAIN ST
Practice Address - Street 2:SUITE A21
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3348
Practice Address - Country:US
Practice Address - Phone:615-824-7780
Practice Address - Fax:615-827-0008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14488251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health