=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801042726
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTEGRITY HOME CARE SERVICES, INC. TBI
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2008
-----------------------------------------------------
Last Update Date | 04/06/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 813 FAY RD
-----------------------------------------------------
City | SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13219-3009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-488-2951
-----------------------------------------------------
Fax | 315-488-2834
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 813 FAY RD
-----------------------------------------------------
City | SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13219-3009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-488-2951
-----------------------------------------------------
Fax | 315-488-2834
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR PATIENT FINANCIAL SERVICES
-----------------------------------------------------
Name | MS. ANN VENTURINI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 315-703-0745
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 9827L001
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | 9827L001
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------