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General NPI Number Information
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NPI Number | 1861047904
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Entity Type | Organization
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Legal Business Name | INDEPENDENT CARE AGENCY
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Dates
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Enumeration Date | 08/06/2019
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Last Update Date | 08/06/2019
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Provider Practice Location Address
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Address Line | 888 S GREENVILLE AVE STE 207
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City | RICHARDSON
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State | TX
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Zip | 75081-5044
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Country | US
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Telephone | 815-701-8389
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Fax |
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Provider Business Mailing Address
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Address Line | 322 CANYON VALLEY DR
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City | RICHARDSON
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State | TX
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Zip | 75080-1934
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Country | US
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Telephone | 815-701-8389
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Fax | 224-206-8672
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Authorized Official
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Title or Position | OWNER/ADMISTRATOR
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Name | STEPHANIE G JOHNSON
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Credential | RN
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Telephone | 815-701-8389
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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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