Provider Demographics
NPI:1447244660
Name:INDEPENDENT HEALTH CARE SERVICES,INC.
Entity Type:Organization
Organization Name:INDEPENDENT HEALTH CARE SERVICES,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:INDI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-477-9308
Mailing Address - Street 1:1050 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2215
Mailing Address - Country:US
Mailing Address - Phone:315-424-3744
Mailing Address - Fax:
Practice Address - Street 1:1050 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-2215
Practice Address - Country:US
Practice Address - Phone:315-424-3744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9785L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00914049Medicaid
NY01030386Medicaid