Provider Demographics
NPI:1639292824
Name:INTEGRATED HOMECARE SERVICES
Entity Type:Organization
Organization Name:INTEGRATED HOMECARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:DIGIOVANNI
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
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:815-227-9807
Practice Address - Street 1:3902 W RIVERSIDE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61101-9507
Practice Address - Country:US
Practice Address - Phone:815-962-0202
Practice Address - Fax:815-963-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid
IL0212820002Medicare ID - Type Unspecified