Healthcare Provider Details

I. General information

NPI: 1396419834
Provider Name (Legal Business Name): IN HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2021
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

597 SHADY GROVE RD
HURTSBORO AL
36860-2815
US

IV. Provider business mailing address

PO BOX 591
HURTSBORO AL
36860-0591
US

V. Phone/Fax

Practice location:
  • Phone: 334-667-6394
  • Fax:
Mailing address:
  • Phone: 334-667-6394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: IVAN EVANS
Title or Position: ADMINISTRATOR
Credential:
Phone: 706-566-9225