Healthcare Provider Details

I. General information

NPI: 1063229425
Provider Name (Legal Business Name): INTEGRATED HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 LIMESTONE RD STE 300
WILMINGTON DE
19808-2156
US

IV. Provider business mailing address

291 CARTER DR STE B
MIDDLETOWN DE
19709-5845
US

V. Phone/Fax

Practice location:
  • Phone: 844-365-2202
  • Fax: 844-558-1878
Mailing address:
  • Phone: 844-365-2202
  • Fax: 844-558-1878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KELSEY ROPER
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 844-365-2202