Provider Demographics
NPI:1962712570
Name:INTEGRA HOME PROVIDER SERVICES
Entity type:Organization
Organization Name:INTEGRA HOME PROVIDER SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-459-9242
Mailing Address - Street 1:1415 MULBERRY LN
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-8263
Mailing Address - Country:US
Mailing Address - Phone:956-459-9242
Mailing Address - Fax:956-542-8902
Practice Address - Street 1:1415 MULBERRY LN
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8263
Practice Address - Country:US
Practice Address - Phone:956-459-9242
Practice Address - Fax:956-542-8902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care