MEDICARE: INTEGRITY HOME CARE, LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1245605351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRITY HOME CARE, LLC.

Provider Business Mailing Address
First Line	:	6450 W FOREST HOME AVE
Second Line	:	UNIT 102
City	:	GREENFIELD
State	:	WI
Zip	:	53220-2402
Country	:	US
Telephone Number	:	414-581-9162
Fax Number	:	414-210-5530

Provider Business Practice Location Address
First Line	:	6450 W FOREST HOME AVE
Second Line	:	UNIT 102
City	:	GREENFIELD
State	:	WI
Zip	:	53220-2402
Country	:	US
Telephone Number	:	414-581-9162
Fax Number	:	414-210-5530

Authorized Official
Title or Position	:	OWNER AND CEO
Name	:	MISS SOUTHIDA XAYACHACK
Credential	:	MSW
Telephone Number	:	414-581-9162

Provider Enumeration Date	:	12/01/2015
Last Update Date	:	07/22/2016

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