Provider Demographics
NPI: | 1497044416 |
---|---|
Name: | I-CARE PRIVATE HOME CARE SERVICES, LLC |
Entity Type: | Organization |
Organization Name: | I-CARE PRIVATE HOME CARE SERVICES, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ALRENE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ALLEN-MARTIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RN |
Authorized Official - Phone: | 678-687-7152 |
Mailing Address - Street 1: | 155 WESTRIDGE PKWY |
Mailing Address - Street 2: | SUITE #208 |
Mailing Address - City: | MCDONOUGH |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30253-3049 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 678-687-7152 |
Mailing Address - Fax: | 678-509-8103 |
Practice Address - Street 1: | 155 WESTRIDGE PKWY |
Practice Address - Street 2: | SUITE #208 |
Practice Address - City: | MCDONOUGH |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30253-3049 |
Practice Address - Country: | US |
Practice Address - Phone: | 678-687-7152 |
Practice Address - Fax: | 678-509-8103 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-03-30 |
Last Update Date: | 2014-01-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
GA | 149168 | 163WC1500X, 163WG0000X, 163WG0600X, 163WH0200X, 163WH1000X, 163WI0500X, 163WM0102X, 163WN1003X, 163WP0000X, 163WP0200X, 163WP0808X, 163WW0000X, 163WX1500X, 251B00000X |
385H00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 163WH0200X | Nursing Service Providers | Registered Nurse | Home Health | Group - Single Specialty |
No | 163WC1500X | Nursing Service Providers | Registered Nurse | Community Health | Group - Single Specialty |
No | 163WG0000X | Nursing Service Providers | Registered Nurse | General Practice | Group - Single Specialty |
No | 163WG0600X | Nursing Service Providers | Registered Nurse | Gerontology | Group - Single Specialty |
No | 163WH1000X | Nursing Service Providers | Registered Nurse | Hospice | Group - Single Specialty |
No | 163WI0500X | Nursing Service Providers | Registered Nurse | Infusion Therapy | Group - Single Specialty |
No | 163WM0102X | Nursing Service Providers | Registered Nurse | Maternal Newborn | Group - Single Specialty |
No | 163WN1003X | Nursing Service Providers | Registered Nurse | Nutrition Support | Group - Single Specialty |
No | 163WP0000X | Nursing Service Providers | Registered Nurse | Pain Management | Group - Single Specialty |
No | 163WP0200X | Nursing Service Providers | Registered Nurse | Pediatrics | Group - Single Specialty |
No | 163WP0808X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health | Group - Single Specialty |
No | 163WW0000X | Nursing Service Providers | Registered Nurse | Wound Care | Group - Single Specialty |
No | 163WX1500X | Nursing Service Providers | Registered Nurse | Ostomy Care | Group - Single Specialty |
No | 251B00000X | Agencies | Case Management | Group - Single Specialty | |
No | 385H00000X | Respite Care Facility | Respite Care | Group - Single Specialty |