Provider Demographics
NPI:1730457433
Name:ICARE HOME HEALTH AGENCY LLC
Entity Type:Organization
Organization Name:ICARE HOME HEALTH AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ADEGBORUWA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:702-485-2377
Mailing Address - Street 1:2411 W CHARLESTON BLVD
Mailing Address - Street 2:ST 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2123
Mailing Address - Country:US
Mailing Address - Phone:702-485-2377
Mailing Address - Fax:702-485-2979
Practice Address - Street 1:2411 W CHARLESTON BLVD
Practice Address - Street 2:ST 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2123
Practice Address - Country:US
Practice Address - Phone:702-485-2377
Practice Address - Fax:702-485-2979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health