Provider Demographics
NPI:1285152363
Name:INTELECARE, LLC.
Entity type:Organization
Organization Name:INTELECARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:HINDS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:908-636-3613
Mailing Address - Street 1:134 COBURN LN
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-4769
Mailing Address - Country:US
Mailing Address - Phone:908-636-3613
Mailing Address - Fax:
Practice Address - Street 1:134 COBURN LN
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-4769
Practice Address - Country:US
Practice Address - Phone:908-636-3613
Practice Address - Fax:908-636-3613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-08
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00597900261QH0100X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty