Provider Demographics
NPI:1154075588
Name:INTEGRATED HABILITATION SERVICES
Entity Type:Organization
Organization Name:INTEGRATED HABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARCIE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-972-1026
Mailing Address - Street 1:305 S FLAGLER AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-7238
Mailing Address - Country:US
Mailing Address - Phone:305-972-1026
Mailing Address - Fax:
Practice Address - Street 1:305 S FLAGLER AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-7238
Practice Address - Country:US
Practice Address - Phone:305-972-1026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000063300Medicaid