Healthcare Provider Details

I. General information

NPI: 1639082324
Provider Name (Legal Business Name): INTEGRATED HEALTH AND SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11003 N 59TH DR
GLENDALE AZ
85304-3744
US

IV. Provider business mailing address

11003 N 59TH DR
GLENDALE AZ
85304-3744
US

V. Phone/Fax

Practice location:
  • Phone: 602-723-1775
  • Fax:
Mailing address:
  • Phone: 602-723-1775
  • Fax: 602-723-1775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: THERESIA FOMECHE
Title or Position: CEO/OWNER
Credential:
Phone: 602-723-1775