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
StateLicense IDTaxonomies
GA149168163WC1500X, 163WG0000X, 163WG0600X, 163WH0200X, 163WH1000X, 163WI0500X, 163WM0102X, 163WN1003X, 163WP0000X, 163WP0200X, 163WP0808X, 163WW0000X, 163WX1500X, 251B00000X
385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty
No163WG0600XNursing Service ProvidersRegistered NurseGerontologyGroup - Single Specialty
No163WH1000XNursing Service ProvidersRegistered NurseHospiceGroup - Single Specialty
No163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Single Specialty
No163WM0102XNursing Service ProvidersRegistered NurseMaternal NewbornGroup - Single Specialty
No163WN1003XNursing Service ProvidersRegistered NurseNutrition SupportGroup - Single Specialty
No163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Single Specialty
No163WP0200XNursing Service ProvidersRegistered NursePediatricsGroup - Single Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty
No163WX1500XNursing Service ProvidersRegistered NurseOstomy CareGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty