Provider Demographics
NPI:1124092861
Name:INTEGRAL HOME HEALTH AGENCY, INC.
Entity type:Organization
Organization Name:INTEGRAL HOME HEALTH AGENCY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CASADEVALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-206-1483
Mailing Address - Street 1:6001 NW 153RD ST STE 141
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2475
Mailing Address - Country:US
Mailing Address - Phone:305-884-3582
Mailing Address - Fax:305-884-3591
Practice Address - Street 1:6001 NW 153RD ST STE 141
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2475
Practice Address - Country:US
Practice Address - Phone:305-884-3582
Practice Address - Fax:305-884-3591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-16
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299991992251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL651110400Medicaid
FL651110400Medicaid