Provider Demographics
NPI:1174755938
Name:INTENSIVE MENTAL CARE INC
Entity type:Organization
Organization Name:INTENSIVE MENTAL CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:COSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-333-0500
Mailing Address - Street 1:PO BOX 1207
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27588-1207
Mailing Address - Country:US
Mailing Address - Phone:252-426-1390
Mailing Address - Fax:
Practice Address - Street 1:317 OCEAN HWY S
Practice Address - Street 2:
Practice Address - City:HERTFORD
Practice Address - State:NC
Practice Address - Zip Code:27944-7902
Practice Address - Country:US
Practice Address - Phone:252-426-1390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency