Provider Demographics
NPI:1720250624
Name:INTEGRATED HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:INTEGRATED HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:POERIO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:860-291-9787
Mailing Address - Street 1:763 BURNSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-2791
Mailing Address - Country:US
Mailing Address - Phone:860-291-9787
Mailing Address - Fax:860-291-2392
Practice Address - Street 1:869 FORBES ST
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06118-1958
Practice Address - Country:US
Practice Address - Phone:860-622-5340
Practice Address - Fax:860-622-5342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008001955Medicaid
CT008002608Medicaid