Healthcare Provider Details

I. General information

NPI: 1811496656
Provider Name (Legal Business Name): ICARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2018
Last Update Date: 02/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 ROBINSON STREET
WESSON MS
39191
US

IV. Provider business mailing address

PO BOX 633
WESSON MS
39191-0633
US

V. Phone/Fax

Practice location:
  • Phone: 601-754-7542
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateMS

VIII. Authorized Official

Name: EVON GLASPER
Title or Position: OWNER
Credential:
Phone: 601-754-7542