Provider Demographics
NPI:1811039670
Name:INTEGRATED HOME CARE, INC.
Entity Type:Organization
Organization Name:INTEGRATED HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODER
Authorized Official - Suffix:
Authorized Official - Credentials:BBA
Authorized Official - Phone:248-424-4881
Mailing Address - Street 1:17550 W 11 MILE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4725
Mailing Address - Country:US
Mailing Address - Phone:248-424-4881
Mailing Address - Fax:248-424-4883
Practice Address - Street 1:17550 W 11 MILE RD
Practice Address - Street 2:SUITE A
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-4725
Practice Address - Country:US
Practice Address - Phone:248-424-4881
Practice Address - Fax:248-424-4883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI237626Medicare Oscar/Certification