Healthcare Provider Details

I. General information

NPI: 1043607211
Provider Name (Legal Business Name): ICARE HOME HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 BETHEL RD STE B-4
SOMERS POINT NJ
08244-2183
US

IV. Provider business mailing address

408 BETHEL RD STE B-4
SOMERS POINT NJ
08244-2183
US

V. Phone/Fax

Practice location:
  • Phone: 609-380-2256
  • Fax: 844-422-7373
Mailing address:
  • Phone: 609-380-2256
  • Fax: 844-422-7373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHP0202700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: OBIOMA MARYANN ASIEGBU RN BSN
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 609-380-2256