Provider Demographics
NPI:1003674870
Name:ICARE WI LLC
Entity Type:Organization
Organization Name:ICARE WI LLC
Other - Org Name:NURSE NEXT DOOR MADISON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SUNDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:BHANDAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-780-6545
Mailing Address - Street 1:210 MONTE DIABLO AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2626
Mailing Address - Country:US
Mailing Address - Phone:408-780-6545
Mailing Address - Fax:
Practice Address - Street 1:1521 N THOMPSON RD
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-6125
Practice Address - Country:US
Practice Address - Phone:408-780-6545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care