Provider Demographics
NPI:1699227553
Name:ICARE HOMECARE LLC
Entity Type:Organization
Organization Name:ICARE HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:MYKERA
Authorized Official - Middle Name:
Authorized Official - Last Name:KITCHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-929-3346
Mailing Address - Street 1:16703 EARLY RISER AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:LAND O' LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638
Mailing Address - Country:US
Mailing Address - Phone:305-929-3346
Mailing Address - Fax:
Practice Address - Street 1:2227 16TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-2739
Practice Address - Country:US
Practice Address - Phone:305-929-3346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No305S00000XManaged Care OrganizationsPoint of Service
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)