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General NPI Number Information
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NPI Number | 1336114354
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Entity Type | Organization
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Legal Business Name | INTEGRICARE, INC
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 716 COLLEGE VIEW DR SUITE C
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City | RIVERTON
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State | WY
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Zip | 82501-2282
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Country | US
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Telephone | 307-856-4127
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Fax | 307-856-4129
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Provider Business Mailing Address
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Address Line | 9 S CHERRY ST
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City | WALLINGFORD
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State | CT
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Zip | 06492-3537
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Country | US
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Telephone | 203-741-6565
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Fax | 203-269-2227
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Authorized Official
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Title or Position | VICE PRESIDENT/CFO
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Name | JON C ESTES
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Credential |
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Telephone | 203-741-6565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 05-055
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License Number State | WY
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