Provider Demographics
NPI:1184957219
Name:INTEGRATED HOME HEATH CARE AGENCY, LLC
Entity type:Organization
Organization Name:INTEGRATED HOME HEATH CARE AGENCY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:ALEXANDRIA
Authorized Official - Last Name:KEATON
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:317-412-8531
Mailing Address - Street 1:8964 COCKERHAM CIR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-5044
Mailing Address - Country:US
Mailing Address - Phone:317-412-8531
Mailing Address - Fax:317-344-3159
Practice Address - Street 1:8964 COCKERHAM CIR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-5044
Practice Address - Country:US
Practice Address - Phone:317-412-8531
Practice Address - Fax:317-344-3159
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATED HOME HEALTH CARE AGENCY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-08
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251B00000X, 251E00000X, 253Z00000X, 347C00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200947300AMedicaid
IN09-012-142-1OtherHOME HEALTH CARE
IN09-012142-1OtherISDH