Provider Demographics
NPI:1396855821
Name:INTEGRATED HOMECARE SERVICES, INC.
Entity Type:Organization
Organization Name:INTEGRATED HOMECARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:HATCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-227-0202
Mailing Address - Street 1:5027 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-8010
Mailing Address - Country:US
Mailing Address - Phone:815-227-0202
Mailing Address - Fax:866-511-5752
Practice Address - Street 1:5027 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-8010
Practice Address - Country:US
Practice Address - Phone:815-227-0202
Practice Address - Fax:815-227-9807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171WH0202X, 332B00000X
IL203.000617332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0212820001OtherMEDICARE PTAN NUMBER
IL=========0001Medicaid