Provider Demographics
NPI:1720313851
Name:ICARE HOME HEALTH PROVIDERS, LLC
Entity Type:Organization
Organization Name:ICARE HOME HEALTH PROVIDERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/AGENCY SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARRERA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:847-745-8424
Mailing Address - Street 1:4836 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2594
Mailing Address - Country:US
Mailing Address - Phone:847-745-8424
Mailing Address - Fax:847-410-2795
Practice Address - Street 1:4836 MAIN ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2594
Practice Address - Country:US
Practice Address - Phone:847-745-8424
Practice Address - Fax:847-410-2795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL02691752251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1011052Medicare Oscar/Certification