Healthcare Provider Details

I. General information

NPI: 1699538736
Provider Name (Legal Business Name): INTEGRA HOME CARE SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6520 US HIGHWAY 301 S STE 104
RIVERVIEW FL
33578-4324
US

IV. Provider business mailing address

6520 US HIGHWAY 301 S STE 104
RIVERVIEW FL
33578-4324
US

V. Phone/Fax

Practice location:
  • Phone: 813-776-1671
  • Fax: 813-400-1084
Mailing address:
  • Phone: 813-776-1671
  • Fax: 813-400-1084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE DELISME
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 813-363-2114