Basic Information
Provider Information | |||||||||
NPI: | 1932174398 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | INTEGRICARE, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | NORTH PLATTE HOME HEALTH AND HOSPICE | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 9 S CHERRY ST | ||||||||
Address2: |   | ||||||||
City: | WALLINGFORD | ||||||||
State: | CT | ||||||||
PostalCode: | 064923537 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2037416565 | ||||||||
FaxNumber: | 2032692227 | ||||||||
Practice Location | |||||||||
Address1: | 130 N ASH ST | ||||||||
Address2: | PROFESSIONAL PLAZA SUITE 201 | ||||||||
City: | CASPER | ||||||||
State: | WY | ||||||||
PostalCode: | 826011821 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3072346684 | ||||||||
FaxNumber: | 3072346066 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/21/2006 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ESTES | ||||||||
AuthorizedOfficialFirstName: | JON | ||||||||
AuthorizedOfficialMiddleName: | C | ||||||||
AuthorizedOfficialTitleorPosition: | VICE PRESIDENT/CFO | ||||||||
AuthorizedOfficialTelephone: | 2037416565 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 05-223 | WY | Y |   | Agencies | Home Health |   |
No ID Information.