=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336246990
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRITY HOME HEALTH CARE SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2006
-----------------------------------------------------
Last Update Date | 03/14/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4150 W PEORIA AVE SUITE 112
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85029-3900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-997-0500
-----------------------------------------------------
Fax | 602-997-4934
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4150 W PEORIA AVE SUITE 112
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85029-3900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-997-0500
-----------------------------------------------------
Fax | 602-997-4934
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. CHRIS J FACTO
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 602-997-0500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------