1902172075 NPI number — INTEGRATED HEALTHCARE ASSOCIATES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902172075 NPI number — INTEGRATED HEALTHCARE ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATED HEALTHCARE ASSOCIATES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902172075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
650 E DEVON AVE
Provider Second Line Business Mailing Address:
SUITE 165
Provider Business Mailing Address City Name:
ITASCA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60143-1251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-285-1040
Provider Business Mailing Address Fax Number:
630-285-1210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 E DEVON AVE
Provider Second Line Business Practice Location Address:
SUITE 165
Provider Business Practice Location Address City Name:
ITASCA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60143-1251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-285-1040
Provider Business Practice Location Address Fax Number:
630-285-1210
Provider Enumeration Date:
03/22/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MAY
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
L
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
630-285-1040

Provider Taxonomy Codes

  • Taxonomy code: 305S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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