Provider Demographics
NPI:1992500474
Name:INTEGRITY CARE CONNECTION LLC
Entity type:Organization
Organization Name:INTEGRITY CARE CONNECTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR RCM GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-225-0489
Mailing Address - Street 1:5160 W SAINT JOHN RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5370
Mailing Address - Country:US
Mailing Address - Phone:623-326-0644
Mailing Address - Fax:
Practice Address - Street 1:9840 SE AMHERST ST
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9168
Practice Address - Country:US
Practice Address - Phone:623-326-0644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health