Healthcare Provider Details
I. General information
NPI: 1497044416
Provider Name (Legal Business Name): I-CARE PRIVATE HOME CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 03/30/2011
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
155 WESTRIDGE PKWY SUITE #208
MCDONOUGH GA
30253-3049
US
IV. Provider business mailing address
155 WESTRIDGE PKWY SUITE #208
MCDONOUGH GA
30253-3049
US
V. Phone/Fax
- Phone: 678-687-7152
- Fax: 678-509-8103
- Phone: 678-687-7152
- Fax: 678-509-8103
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 251B00000X |
| Taxonomy | Case Management Agency |
| License Number | 149168 |
| License Number State | GA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC1500X |
| Taxonomy | Community Health Registered Nurse |
| License Number | 149168 |
| License Number State | GA |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WG0000X |
| Taxonomy | General Practice Registered Nurse |
| License Number | 149168 |
| License Number State | GA |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WG0600X |
| Taxonomy | Gerontology Registered Nurse |
| License Number | 149168 |
| License Number State | GA |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WH1000X |
| Taxonomy | Hospice Registered Nurse |
| License Number | 149168 |
| License Number State | GA |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WI0500X |
| Taxonomy | Infusion Therapy Registered Nurse |
| License Number | 149168 |
| License Number State | GA |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WM0102X |
| Taxonomy | Maternal Newborn Registered Nurse |
| License Number | 149168 |
| License Number State | GA |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WN1003X |
| Taxonomy | Nutrition Support Registered Nurse |
| License Number | 149168 |
| License Number State | GA |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0000X |
| Taxonomy | Pain Management Registered Nurse |
| License Number | 149168 |
| License Number State | GA |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0200X |
| Taxonomy | Pediatric Registered Nurse |
| License Number | 149168 |
| License Number State | GA |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0808X |
| Taxonomy | Psychiatric/Mental Health Registered Nurse |
| License Number | 149168 |
| License Number State | GA |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WW0000X |
| Taxonomy | Wound Care Registered Nurse |
| License Number | 149168 |
| License Number State | GA |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WX1500X |
| Taxonomy | Ostomy Care Registered Nurse |
| License Number | 149168 |
| License Number State | GA |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 385H00000X |
| Taxonomy | Respite Care |
| License Number | |
| License Number State | |
| # 15 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 163WH0200X |
| Taxonomy | Home Health Registered Nurse |
| License Number | 149168 |
| License Number State | GA |
VIII. Authorized Official
Name:
ALRENE
ALLEN-MARTIN
Title or Position: CEO
Credential: RN
Phone: 678-687-7152
