Provider Demographics
NPI:1659346823
Name:INTEGRICARE, INC.
Entity Type:Organization
Organization Name:INTEGRICARE, INC.
Other - Org Name:DOUGLAS HOMECARE AND HOSPICE
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:203-741-6464
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:203-741-6464
Mailing Address - Fax:203-269-2227
Practice Address - Street 1:500 SE CASS AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3103
Practice Address - Country:US
Practice Address - Phone:541-440-2583
Practice Address - Fax:541-440-2530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR09-2863Medicaid
381518Medicare ID - Type UnspecifiedMEDICARE HOSPICE