Organization
INTEGRETED COMPREHENSIVE HEALTH CARE
Active
Parent organization
ICHC,LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
ICHC,LLC
Authorized official
MR. SHANNON DEJAUN JACKSON (CASE MANGER)
(405) 830-1094
Entity
Organization
Contact information
Practice address
4801 N CLASSEN BLVD # 73118, OKLAHOMA CITY, OK 73118-4627
(405) 843-7300
(405) 843-1306
Mailing address
4801 N CLASSEN BLVD # 73118, OKLAHOMA CITY, OK 73118-4627
(405) 843-7300
(405) 843-1306
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SHIZZ10
—
OK
Enumeration date
04/25/2012
Last updated
04/25/2012
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