MEDICARE: I CARE HOME SERVICE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1063113462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	I CARE HOME SERVICE, LLC

Provider Business Mailing Address
First Line	:	2200 DULUTH HWY APT 2213
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30097-4150
Country	:	US
Telephone Number	:	404-422-8853
Fax Number	:	470-275-0991

Provider Business Practice Location Address
First Line	:	2200 DULUTH HWY APT 2213
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30097-4150
Country	:	US
Telephone Number	:	404-422-8853
Fax Number	:	470-275-0991

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SONG KIL KIM
Credential	:
Telephone Number	:	404-422-8853

Provider Enumeration Date	:	03/13/2023
Last Update Date	:	03/13/2023

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Directions to “I CARE HOME SERVICE, LLC ” Practice Location

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