Provider Demographics
NPI:1346247442
Name:INTEGRACARE HOME HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:INTEGRACARE HOME HEALTH SERVICES INC.
Other - Org Name:CENTERWELL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-778-6334
Mailing Address - Street 1:6330 SPRINT PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1157
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2626 S 37TH ST STE 102
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7136
Practice Address - Country:US
Practice Address - Phone:254-778-6334
Practice Address - Fax:254-778-6524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012075251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000900200Medicaid
TX000902300Medicaid
TX000958500Medicaid
TX001002205Medicaid
TX000016100Medicaid
TX000110400Medicaid
TX000900100Medicaid
TX000900400Medicaid
TX000040300Medicaid
TX000051300Medicaid
TX000050300Medicaid
TX000900300Medicaid
TX000060400Medicaid
TX000900500Medicaid
TX000042000Medicaid
TX000040300Medicaid
TX001002205Medicaid