Healthcare Provider Details

I. General information

NPI: 1336850213
Provider Name (Legal Business Name): ICARE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1468 FRAZIER LN
DECATUR GA
30033-1857
US

IV. Provider business mailing address

4112 BELLA VIEW DR
SNELLVILLE GA
30039-3208
US

V. Phone/Fax

Practice location:
  • Phone: 404-706-4950
  • Fax: 470-607-0686
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DENNISE CORNEJO
Title or Position: OWNER
Credential:
Phone: 213-840-7409