Healthcare Provider Details

I. General information

NPI: 1932174398
Provider Name (Legal Business Name): INTEGRICARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 N ASH ST PROFESSIONAL PLAZA SUITE 201
CASPER WY
82601-1821
US

IV. Provider business mailing address

9 S CHERRY ST
WALLINGFORD CT
06492-3537
US

V. Phone/Fax

Practice location:
  • Phone: 307-234-6684
  • Fax: 307-234-6066
Mailing address:
  • Phone: 203-741-6565
  • Fax: 203-269-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number05-223
License Number StateWY

VIII. Authorized Official

Name: JON C ESTES
Title or Position: VICE PRESIDENT/CFO
Credential:
Phone: 203-741-6565