Provider Demographics
NPI:1851853139
Name:IGM SENIOR CARE LLC
Entity Type:Organization
Organization Name:IGM SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BURNS
Authorized Official - Last Name:MCGOFF
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:724-877-3505
Mailing Address - Street 1:3580 INNOVATION WAY STE 104
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-7910
Mailing Address - Country:US
Mailing Address - Phone:724-877-3505
Mailing Address - Fax:
Practice Address - Street 1:3580 INNOVATION WAY STE 104
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-7910
Practice Address - Country:US
Practice Address - Phone:724-877-3505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA37543601OtherSTATE LICENSE