Integration Group Home LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

INTEGRATION GROUP HOME LLC

Practice address

4800 San Remo Dr
Mansfield, TX 76063-8642

Phone

(612) 227-5811

NPI assigned

Jun 19, 2024

Organization subpart

No

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

Authorized official

Name

Stephanie Ndifor Fomekon

Title

Ceo/Manager

Phone

(612) 227-5811

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1718755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718755200000",
    "number": "1861236440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 SAN REMO DR",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760638642",
            "telephone_number": "612-227-5811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 SAN REMO DR",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760638642",
            "telephone_number": "612-227-5811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATION GROUP HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-19",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-19",
        "status": "A",
        "authorized_official_last_name": "FOMEKON",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "NDIFOR",
        "authorized_official_title_or_position": "CEO/MANAGER",
        "authorized_official_telephone_number": "612-227-5811"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Mansfield, TX by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2024; 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.