Healthcare Provider Details

I. General information

NPI: 1447244660
Provider Name (Legal Business Name): INDEPENDENT HEALTH CARE SERVICES,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 W GENESEE ST
SYRACUSE NY
13204-2215
US

IV. Provider business mailing address

1050 W GENESEE ST
SYRACUSE NY
13204-2215
US

V. Phone/Fax

Practice location:
  • Phone: 315-424-3744
  • Fax:
Mailing address:
  • Phone: 315-424-3744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number9785L001
License Number StateNY

VIII. Authorized Official

Name: MS. INDI SHELBY
Title or Position: PRESIDENT/CEO
Credential:
Phone: 315-477-9308