Provider Demographics
NPI:1710163852
Name:INTEGRA HOME CARE, INC.
Entity Type:Organization
Organization Name:INTEGRA HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DIMITRIY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPKOV
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:952-985-0672
Mailing Address - Street 1:20730 HOLYOKE AVE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-9826
Mailing Address - Country:US
Mailing Address - Phone:952-985-0672
Mailing Address - Fax:952-985-0675
Practice Address - Street 1:20730 HOLYOKE AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-9826
Practice Address - Country:US
Practice Address - Phone:952-985-0672
Practice Address - Fax:952-985-0675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-19
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN338318251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN338318OtherCLASS A LICENCE