MEDICARE: I CARE ASSISTANCE LIVING SERVICES 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1467154856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	I CARE ASSISTANCE LIVING SERVICES LLC

Provider Business Mailing Address
First Line	:	3694 BLAKE CANYON DR
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-0834
Country	:	US
Telephone Number	:	661-728-8815
Fax Number	:

Provider Business Practice Location Address
First Line	:	3694 BLAKE CANYON DR
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-0834
Country	:	US
Telephone Number	:	661-728-8815
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DONALD SANDERS
Credential	:
Telephone Number	:	661-728-8815

Provider Enumeration Date	:	03/20/2023
Last Update Date	:	03/20/2023

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