Healthcare Provider Details

I. General information

NPI: 1003265059
Provider Name (Legal Business Name): IDEAL CARE PROVIDERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2032 MARGARITE ST
MONROEVILLE PA
15146-4523
US

IV. Provider business mailing address

2032 MARGARITE ST
MONROEVILLE PA
15146-4523
US

V. Phone/Fax

Practice location:
  • Phone: 412-646-5186
  • Fax: 412-349-8365
Mailing address:
  • Phone: 412-646-5186
  • Fax: 412-349-8365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number30623601
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number30623601
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number30623601
License Number StatePA

VIII. Authorized Official

Name: MR. IKECHUKWU AMAECHI
Title or Position: CEO
Credential:
Phone: 412-646-5186