Provider Demographics
NPI:1134661911
Name:INTEGRATED HEALTH SERVICES OF AMERICA
Entity Type:Organization
Organization Name:INTEGRATED HEALTH SERVICES OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALICEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-309-2548
Mailing Address - Street 1:601 SE 5TH CT APT 201
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2943
Mailing Address - Country:US
Mailing Address - Phone:954-309-2548
Mailing Address - Fax:
Practice Address - Street 1:601 SE 5TH CT APT 201
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2943
Practice Address - Country:US
Practice Address - Phone:954-309-2548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018386300Medicaid