Provider Demographics
NPI:1013464536
Name:INTECLINCO HOME HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:INTECLINCO HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENEPHER
Authorized Official - Middle Name:JUDITH
Authorized Official - Last Name:NALYANYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,MPH, MS, BSN
Authorized Official - Phone:407-409-9128
Mailing Address - Street 1:PO BOX 120-872
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02112-2309
Mailing Address - Country:US
Mailing Address - Phone:857-334-4186
Mailing Address - Fax:
Practice Address - Street 1:19 MILLSTONE RD
Practice Address - Street 2:APT. 2
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-2309
Practice Address - Country:US
Practice Address - Phone:857-334-4186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health