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General NPI Number Information
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NPI Number | 1023548898
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Entity Type | Organization
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Legal Business Name | I CARE HOME PROVIDER INC
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Dates
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Enumeration Date | 06/14/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 29158 LONGVIEW AVE APT 12
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City | WARREN
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State | MI
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Zip | 48093-2441
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Country | US
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Telephone | 586-707-1121
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Fax |
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Provider Business Mailing Address
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Address Line | 29158 LONGVIEW AVE APT 12
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City | WARREN
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State | MI
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Zip | 48093-2441
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Country | US
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Telephone | 586-707-1121
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | WALEED SADIK
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Credential |
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Telephone | 586-707-1121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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