Basic Information
| Provider Information | |||||||||
| NPI: | 1346247442 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INTEGRACARE HOME HEALTH SERVICES INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | CENTERWELL HOME HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
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| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 6330 SPRINT PKWY STE 300 | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662111157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9138142716 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2626 S 37TH ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | TEMPLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 765047136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547786334 | ||||||||
| FaxNumber: | 2547786524 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2005 | ||||||||
| LastUpdateDate: | 06/01/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SKAGGS | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED SIGNATORY | ||||||||
| AuthorizedOfficialTelephone: | 9138142716 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 012075 | TX | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 000902300 | 05 | TX | MEDICAID | 000040300 | 05 | TX | MEDICAID | 000900100 | 05 | TX | MEDICAID | 000051300 | 05 | TX | MEDICAID | 000900200 | 05 | TX | MEDICAID | 000958500 | 05 | TX | MEDICAID | 000110400 | 05 | TX | MEDICAID | 000900500 | 05 | TX | MEDICAID | 000050300 | 05 | TX | MEDICAID | 000060400 | 05 | TX | MEDICAID | 001002205 | 05 | TX | MEDICAID | 000016100 | 05 | TX | MEDICAID | 000042000 | 05 | TX | MEDICAID | 000900300 | 05 | TX | MEDICAID | 000900400 | 05 | TX | MEDICAID |