=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194115733
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRITY PLUS HEALTHCARE STAFFING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2015
-----------------------------------------------------
Last Update Date | 02/04/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1224 N HIGHWAY 377 SUITE 303/101
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76262-9103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-490-1233
-----------------------------------------------------
Fax | 817-490-1233
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1224 N HIGHWAY 377 SUITE 303/101
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76262-9103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-490-1233
-----------------------------------------------------
Fax | 817-490-1233
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE VICE PRESIDENT
-----------------------------------------------------
Name | MR. ANDREW JAMES RAINWATER
-----------------------------------------------------
Credential | BSEE/MBA
-----------------------------------------------------
Telephone | 817-823-6125
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 212165
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 110089
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------