Provider Demographics
NPI:1831378751
Name:IMPLICARE,LLC
Entity type:Organization
Organization Name:IMPLICARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBANA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:972-414-5841
Mailing Address - Street 1:2514 PEPPERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-7426
Mailing Address - Country:US
Mailing Address - Phone:972-414-5841
Mailing Address - Fax:972-495-3211
Practice Address - Street 1:2514 PEPPERIDGE DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-7426
Practice Address - Country:US
Practice Address - Phone:972-414-5841
Practice Address - Fax:972-495-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-27
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010112251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health