| Organization Name: | INTEGRATED CARE MANAGEMENT SOLUTIONS |
| NPI Number: | 1043622137 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEFF PAYNE (EXECUTIVE DIRECTOR) |
| Mailing Address: | 544 S Main St Suite B Fort Bragg |
| State: | CA US |
| Postal Code: | 954375107 |
| Phone Number: | 7079610172 |
| Fax Number: | 7079610127 |
| NPI Enumeration Date: | 05/23/2014 |
| NPI Last Update Date: | 10/20/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0801X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
| Taxonomy Definition: | |