Healthcare Provider Details

I. General information

NPI: 1396855821
Provider Name (Legal Business Name): INTEGRATED HOMECARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5027 HARRISON AVE
ROCKFORD IL
61108-8010
US

IV. Provider business mailing address

5027 HARRISON AVE
ROCKFORD IL
61108-8010
US

V. Phone/Fax

Practice location:
  • Phone: 815-227-0202
  • Fax: 815-227-9807
Mailing address:
  • Phone: 815-227-0202
  • Fax: 866-511-5752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number203.000617
License Number StateIL

VIII. Authorized Official

Name: MR. MARK T HATCH
Title or Position: PRESIDENT
Credential:
Phone: 815-227-0202