Provider Demographics
NPI:1992460182
Name:INTERACTIVE COMMUNITY INITIATIVES LLC.
Entity type:Organization
Organization Name:INTERACTIVE COMMUNITY INITIATIVES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFFER
Authorized Official - Middle Name:JO
Authorized Official - Last Name:FRISKNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-760-9205
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:PLEASANT LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46779-0062
Mailing Address - Country:US
Mailing Address - Phone:260-760-9205
Mailing Address - Fax:
Practice Address - Street 1:1995 N 110 W
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-7639
Practice Address - Country:US
Practice Address - Phone:260-760-9205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty