Healthcare Provider Details

I. General information

NPI: 1720874019
Provider Name (Legal Business Name): INTEGRATED HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 NW 14TH AVE
DANIA BEACH FL
33004-2614
US

IV. Provider business mailing address

11216 NW 7TH ST
CORAL SPRINGS FL
33071-7957
US

V. Phone/Fax

Practice location:
  • Phone: 954-681-2881
  • Fax: 954-656-0194
Mailing address:
  • Phone: 954-681-2881
  • Fax: 954-656-0194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HERBERT GOLDWIRE
Title or Position: ADVANCED PRACTICE REGISTERED NURSE
Credential: APRN
Phone: 954-681-2881