Provider Demographics
NPI:1174949770
Name:INTEGRATIVE HOME HEALTH PALLIATIVE & HOSPICE CARE, LLC
Entity type:Organization
Organization Name:INTEGRATIVE HOME HEALTH PALLIATIVE & HOSPICE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERSON
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:RIDGEWAY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:248-613-1221
Mailing Address - Street 1:1707 CAMPAU FARMS CIR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-5169
Mailing Address - Country:US
Mailing Address - Phone:248-613-1221
Mailing Address - Fax:
Practice Address - Street 1:1707 CAMPAU FARMS CIR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-5169
Practice Address - Country:US
Practice Address - Phone:248-613-1221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251G00000XAgenciesHospice Care, Community Based
No253Z00000XAgenciesIn Home Supportive Care