Provider Demographics
NPI:1437328796
Name:I-CARE PRIVATE HOME CARE SERVICES, LLC
Entity type:Organization
Organization Name:I-CARE PRIVATE HOME CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN-MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:678-687-7152
Mailing Address - Street 1:256 LASSITER DR
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-2983
Mailing Address - Country:US
Mailing Address - Phone:678-687-7152
Mailing Address - Fax:770-474-3076
Practice Address - Street 1:256 LASSITER DR
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-2983
Practice Address - Country:US
Practice Address - Phone:678-663-9597
Practice Address - Fax:770-474-3076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA314000000X
GA149168251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility