MEDICARE: INTEGRATED HOMECARE SERVICES, INC.

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	171WH0202X	Home Modifications Contractor
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	332BX2000X	Oxygen Equipment & Supplies (DME)	203.000617	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0212820001	OTHER	IL	MEDICARE PTAN NUMBER

General Provider Information

NPI Number	:	1396855821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED HOMECARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	5027 HARRISON AVE
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-8010
Country	:	US
Telephone Number	:	815-227-0202
Fax Number	:	866-511-5752

Provider Business Practice Location Address
First Line	:	5027 HARRISON AVE
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-8010
Country	:	US
Telephone Number	:	815-227-0202
Fax Number	:	815-227-9807

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MARK T HATCH
Credential	:
Telephone Number	:	815-227-0202

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	04/24/2023

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