Healthcare Provider Details

I. General information

NPI: 1598280547
Provider Name (Legal Business Name): ICARE HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11047 PIERSON DR STE F
FREDERICKSBURG VA
22408-2062
US

IV. Provider business mailing address

11047 PIERSON DR STE F
FREDERICKSBURG VA
22408-2062
US

V. Phone/Fax

Practice location:
  • Phone: 540-993-4492
  • Fax:
Mailing address:
  • Phone: 540-993-4492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCO-1692
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberHCO-1692
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberHCO-1692
License Number StateVA

VIII. Authorized Official

Name: KEVIN WILLIAMS
Title or Position: ASSISTANT ADMINISTRATOR
Credential:
Phone: 540-993-4492