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General NPI Number Information
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NPI Number | 1437328796
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Entity Type | Organization
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Legal Business Name | I-CARE PRIVATE HOME CARE SERVICES, LLC
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Dates
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Enumeration Date | 02/20/2008
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Last Update Date | 04/16/2009
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Provider Practice Location Address
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Address Line | 256 LASSITER DR
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City | ELLENWOOD
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State | GA
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Zip | 30294-2983
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Country | US
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Telephone | 678-663-9597
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Fax | 770-474-3076
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Provider Business Mailing Address
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Address Line | 256 LASSITER DR
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City | ELLENWOOD
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State | GA
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Zip | 30294-2983
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Country | US
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Telephone | 678-687-7152
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Fax | 770-474-3076
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Authorized Official
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Title or Position | CEO/MANAGER
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Name | MRS. ALRENE ALLEN-MARTIN
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Credential | RN
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Telephone | 678-687-7152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 149168
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License Number State | GA
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