MEDICARE: ICARE HOME HEALTH AGENCY 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	:	1730457433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ICARE HOME HEALTH AGENCY LLC

Provider Business Mailing Address
First Line	:	2411 W CHARLESTON BLVD
Second Line	:	ST 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2123
Country	:	US
Telephone Number	:	702-485-2377
Fax Number	:	702-485-2979

Provider Business Practice Location Address
First Line	:	2411 W CHARLESTON BLVD
Second Line	:	ST 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2123
Country	:	US
Telephone Number	:	702-485-2377
Fax Number	:	702-485-2979

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. LATASHA S ADEGBORUWA
Credential	:	RN, BSN
Telephone Number	:	702-485-2377

Provider Enumeration Date	:	12/08/2011
Last Update Date	:	05/08/2012

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Directions to “ICARE HOME HEALTH AGENCY LLC ” Practice Location

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