MEDICARE: I CARE HOME HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1134775091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	I CARE HOME HEALTH LLC

Provider Business Mailing Address
First Line	:	2302 RED CREEK RD
Second Line	:
City	:	MILLRY
State	:	AL
Zip	:	36558-8462
Country	:	US
Telephone Number	:	601-410-2597
Fax Number	:

Provider Business Practice Location Address
First Line	:	2302 RED CREEK RD
Second Line	:
City	:	MILLRY
State	:	AL
Zip	:	36558-8462
Country	:	US
Telephone Number	:	601-410-2597
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JEKITA MOODY
Credential	:
Telephone Number	:	601-410-2597

Provider Enumeration Date	:	08/15/2019
Last Update Date	:	08/15/2019

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Directions to “I CARE HOME HEALTH LLC ” Practice Location

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