Provider Demographics
NPI:1770742801
Name:INDEPENDENCE HEALTHCARE CORPORATION
Entity type:Organization
Organization Name:INDEPENDENCE HEALTHCARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, ADMINISTRATION & FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:R
Authorized Official - Last Name:RUGGLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-767-1776
Mailing Address - Street 1:100 GROVE ST STE 310
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2627
Mailing Address - Country:US
Mailing Address - Phone:508-767-1776
Mailing Address - Fax:508-767-1726
Practice Address - Street 1:100 GROVE ST STE 310
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2627
Practice Address - Country:US
Practice Address - Phone:508-767-1776
Practice Address - Fax:508-767-1726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7133251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health