Provider Demographics
NPI:1134775091
Name:I CARE HOME HEALTH LLC
Entity type:Organization
Organization Name:I CARE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEKITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-410-2597
Mailing Address - Street 1:2302 RED CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MILLRY
Mailing Address - State:AL
Mailing Address - Zip Code:36558-8462
Mailing Address - Country:US
Mailing Address - Phone:601-410-2597
Mailing Address - Fax:
Practice Address - Street 1:2302 RED CREEK RD
Practice Address - Street 2:
Practice Address - City:MILLRY
Practice Address - State:AL
Practice Address - Zip Code:36558-8462
Practice Address - Country:US
Practice Address - Phone:601-410-2597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health