Provider Demographics
NPI:1427767342
Name:INTEGRATED COMMUNITY OPTIONS, INC.
Entity type:Organization
Organization Name:INTEGRATED COMMUNITY OPTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEWALT
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-926-3519
Mailing Address - Street 1:PO BOX 93577
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91109-3577
Mailing Address - Country:US
Mailing Address - Phone:626-926-3519
Mailing Address - Fax:626-791-5551
Practice Address - Street 1:324 WAPELLO ST
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-4445
Practice Address - Country:US
Practice Address - Phone:626-926-3519
Practice Address - Fax:626-791-5551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility