Healthcare Provider Details

I. General information

NPI: 1720828437
Provider Name (Legal Business Name): I CARE SENIOR CARE HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 CLINE SMITH RD NE
CARTERSVILLE GA
30121-5142
US

IV. Provider business mailing address

269 MARKET PLACE BLVD # 259
CARTERSVILLE GA
30121-2235
US

V. Phone/Fax

Practice location:
  • Phone: 706-979-1468
  • Fax:
Mailing address:
  • Phone: 706-979-1468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MAKEDA FRANCIN MORRIS
Title or Position: CEO
Credential:
Phone: 706-979-1468