Provider Demographics
NPI:1376864819
Name:INCREDIBLE CARE
Entity Type:Organization
Organization Name:INCREDIBLE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/STNA
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:THORPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-510-0625
Mailing Address - Street 1:38 ELMWOOD AVE E
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-3531
Mailing Address - Country:US
Mailing Address - Phone:937-510-0625
Mailing Address - Fax:
Practice Address - Street 1:38 ELMWOOD AVE E
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-3531
Practice Address - Country:US
Practice Address - Phone:937-510-0625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400450840105251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health