Basic Information
| Provider Information | |||||||||
| NPI: | 1659346823 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INTEGRICARE, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DOUGLAS HOMECARE AND HOSPICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 S CHERRY ST | ||||||||
| Address2: | |||||||||
| City: | WALLINGFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064923537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037416464 | ||||||||
| FaxNumber: | 2032692227 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 SE CASS AVE | ||||||||
| Address2: | SUITE 260 | ||||||||
| City: | ROSEBURG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974703103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414402583 | ||||||||
| FaxNumber: | 5414402530 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ESTES | ||||||||
| AuthorizedOfficialFirstName: | JON | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT/CFO | ||||||||
| AuthorizedOfficialTelephone: | 2037416464 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | NA | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 09-2863 | 05 | OR | MEDICAID |