Integrated Care Services, Inc.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

INTEGRATED CARE SERVICES, INC.

Practice address

630 Lige St
Rock Hill, SC 29730-5641

Phone

(910) 331-9578

NPI assigned

Dec 6, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Derrick Jerome Green Sr., BS,QP

Title

C.E.O.

Phone

(910) 331-9578

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1354752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426723200000",
    "number": "1063757722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 LIGE ST",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297305641",
            "telephone_number": "910-331-9578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 LIGE ST",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297305641",
            "telephone_number": "910-331-9578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED CARE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-06",
        "last_updated": "2015-03-19",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_middle_name": "JEROME",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "910-331-9578",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "BS,QP"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000000",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Rock Hill, SC
• Providers in Rock Hill, SC by specialty
• Community/Behavioral Health Agency in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.