1497044416 NPI number — I-CARE PRIVATE HOME CARE SERVICES, LLC

Table of content: (NPI 1497044416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497044416 NPI number — I-CARE PRIVATE HOME CARE SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
I-CARE PRIVATE HOME CARE SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497044416
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155 WESTRIDGE PKWY
Provider Second Line Business Mailing Address:
SUITE #208
Provider Business Mailing Address City Name:
MCDONOUGH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30253-3049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-687-7152
Provider Business Mailing Address Fax Number:
678-509-8103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 WESTRIDGE PKWY
Provider Second Line Business Practice Location Address:
SUITE #208
Provider Business Practice Location Address City Name:
MCDONOUGH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30253-3049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-687-7152
Provider Business Practice Location Address Fax Number:
678-509-8103
Provider Enumeration Date:
03/30/2011

Additional Information

Authorized Official

Authorized Official Last Name:
ALLEN-MARTIN
Authorized Official First Name:
ALRENE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
678-687-7152

Provider Taxonomy Codes

  • Taxonomy code: 163WC1500X , with the licence number:  149168 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WG0000X , with the licence number: 149168 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WG0600X , with the licence number: 149168 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WH0200X , with the licence number: 149168 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163WH1000X , with the licence number: 149168 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WI0500X , with the licence number: 149168 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WM0102X , with the licence number: 149168 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WN1003X , with the licence number: 149168 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0000X , with the licence number: 149168 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0200X , with the licence number: 149168 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0808X , with the licence number: 149168 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WW0000X , with the licence number: 149168 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WX1500X , with the licence number: 149168 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X , with the licence number: 149168 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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