Provider Demographics
NPI:1326013210
Name:INTEGRICARE, INC
Entity Type:Organization
Organization Name:INTEGRICARE, INC
Other - Org Name:EXTEND A CARE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/CFO
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:C
Authorized Official - Last Name:ESTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-741-6565
Mailing Address - Street 1:9 S CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-3537
Mailing Address - Country:US
Mailing Address - Phone:203-741-6565
Mailing Address - Fax:203-269-2227
Practice Address - Street 1:145 GEORGE ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2607
Practice Address - Country:US
Practice Address - Phone:304-253-2273
Practice Address - Fax:304-253-3930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVCON251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0170105000Medicaid
517054BMedicare ID - Type UnspecifiedMEDICARE HH