=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871151340
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | I KARE HEALTHCARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2019
-----------------------------------------------------
Last Update Date | 08/05/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1507 HARDY ST STE 207
-----------------------------------------------------
City | HATTIESBURG
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39401-4978
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-602-4793
-----------------------------------------------------
Fax | 601-602-4905
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1507 HARDY ST STE 207
-----------------------------------------------------
City | HATTIESBURG
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39401-4978
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-602-4793
-----------------------------------------------------
Fax | 601-602-4905
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MISS TARA DENISE RAWLS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 769-456-1139
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------