Provider Demographics
NPI:1467948786
Name:I CARE HOME SERVICES
Entity Type:Organization
Organization Name:I CARE HOME SERVICES
Other - Org Name:I CARE HOME SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EBONI
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-686-4280
Mailing Address - Street 1:PO BOX 1104
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48121-1104
Mailing Address - Country:US
Mailing Address - Phone:248-686-4280
Mailing Address - Fax:
Practice Address - Street 1:16610 WORMER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-3679
Practice Address - Country:US
Practice Address - Phone:248-686-4280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS820386526253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAS820386526OtherADULT FOSTER CARE FACILITY