=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366592594
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRAL HOME HEALTH CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2007
-----------------------------------------------------
Last Update Date | 04/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2364 PLAINFIELD RD
-----------------------------------------------------
City | CREST HILL
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60435-1800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-730-3358
-----------------------------------------------------
Fax | 815-730-3331
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2364 PLAINFIELD RD
-----------------------------------------------------
City | CREST HILL
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60435-1800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-730-3358
-----------------------------------------------------
Fax | 815-730-3331
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. VICTORIA L. SY
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 815-730-3358
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1010476
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------