MEDICARE: IDEAL CARE HOMES INC.

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	164W00000X	Licensed Practical Nurse

General Provider Information

NPI Number	:	1447180823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDEAL CARE HOMES INC.

Provider Business Mailing Address
First Line	:	4205 164TH AVE SE
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98006-8940
Country	:	US
Telephone Number	:	425-503-6680
Fax Number	:	425-292-2881

Provider Business Practice Location Address
First Line	:	4205 164TH AVE SE
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98006-8940
Country	:	US
Telephone Number	:	425-503-6680
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. DORINA LILIANA ILISAN
Credential	:	LPN
Telephone Number	:	425-503-6680

Provider Enumeration Date	:	05/19/2026
Last Update Date	:	05/19/2026

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