IHC Branch Info Update - Interim HealthCare

Thank you for visiting this page! We are working around the clock to ensure that we can serve our offices to the highest level. As a part of our data reconciliation efforts, we ask that you take a moment to fill out the form below to provide us with the most up to date information. Thank you!

Name *

First

Last

Interim HealthCare Branch *

Please list the IHC Branch Office that you are submitting this information for.

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Please list the address of your IHC Branch Office

Counties Served *

Please list the counties that your IHC Branch Office currently serves. Please list only ONE county per line (press ENTER after every county, if listing more than one county)

Phone Number *

Please list the primary phone number of your IHC Branch Office

Fax Number *

Please list the primary fax number of your IHC Branch Office

Point of Contact *

Please list the Point of Contact for your office (First Name, Last Name). If you are the Point of Contact please list your name again.