Provider Demographics
NPI:1013188309
Name:INTEGRI HOME CARE
Entity Type:Organization
Organization Name:INTEGRI HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAWLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-794-5530
Mailing Address - Street 1:208 E WATER ST
Mailing Address - Street 2:208 EAST WATER STREET
Mailing Address - City:WINDSOR
Mailing Address - State:NC
Mailing Address - Zip Code:27983-6741
Mailing Address - Country:US
Mailing Address - Phone:252-794-5530
Mailing Address - Fax:252-794-6599
Practice Address - Street 1:208 E WATER ST
Practice Address - Street 2:208 EAST WATER STREET
Practice Address - City:WINDSOR
Practice Address - State:NC
Practice Address - Zip Code:27983-6741
Practice Address - Country:US
Practice Address - Phone:252-794-5530
Practice Address - Fax:252-794-6599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3606251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418340Medicaid