Provider Demographics
NPI:1144691718
Name:INTEGRATED MEDICAL AND COMMUNITY HEALTH SERVICES INC.
Entity type:Organization
Organization Name:INTEGRATED MEDICAL AND COMMUNITY HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:MARIELLA
Authorized Official - Last Name:MENIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-930-1188
Mailing Address - Street 1:10193 LONGORIA ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-8047
Mailing Address - Country:US
Mailing Address - Phone:818-930-1188
Mailing Address - Fax:
Practice Address - Street 1:5 POTTER LN
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-5313
Practice Address - Country:US
Practice Address - Phone:818-930-1188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70370328261QC1500X, 261QH0100X, 261QP1100X, 261QU0200X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care