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General NPI Number Information
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NPI Number | 1730457433
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Entity Type | Organization
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Legal Business Name | ICARE HOME HEALTH AGENCY LLC
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Dates
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Enumeration Date | 12/08/2011
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Last Update Date | 05/08/2012
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Provider Practice Location Address
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Address Line | 2411 W CHARLESTON BLVD ST 100
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City | LAS VEGAS
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State | NV
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Zip | 89102-2123
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Country | US
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Telephone | 702-485-2377
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Fax | 702-485-2979
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Provider Business Mailing Address
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Address Line | 2411 W CHARLESTON BLVD ST 100
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City | LAS VEGAS
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State | NV
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Zip | 89102-2123
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Country | US
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Telephone | 702-485-2377
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Fax | 702-485-2979
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. LATASHA S ADEGBORUWA
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Credential | RN, BSN
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Telephone | 702-485-2377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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