Provider Demographics
NPI:1962547745
Name:INDEPENDENT CASE MANAGEMENT, INC.
Entity type:Organization
Organization Name:INDEPENDENT CASE MANAGEMENT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:501-228-0063
Mailing Address - Street 1:1525 MERRILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-1821
Mailing Address - Country:US
Mailing Address - Phone:501-228-0063
Mailing Address - Fax:501-228-0070
Practice Address - Street 1:1525 MERRILL DRIVE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-1821
Practice Address - Country:US
Practice Address - Phone:501-228-0063
Practice Address - Fax:501-228-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR196924706Medicaid
AR129558732Medicaid
AR129701767Medicaid
AR132608786OtherDDS
AR130082782Medicaid
AR125831774Medicaid
AR134456775Medicaid
AR193204724Medicaid