Basic Information
| Provider Information | |||||||||
| NPI: | 1841736188 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | I CARE ENTERPRISES LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | ALWAYS BEST CARE OF ALBUQUERQUE - RIO RANCHO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 6300 RIVERSIDE PLAZA LN NW | ||||||||
| Address2: | SUITE # 100 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871202617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058986262 | ||||||||
| FaxNumber: | 5057969601 | ||||||||
| Practice Location | |||||||||
| Address1: | 6300 RIVERSIDE PLAZA LN NW | ||||||||
| Address2: | SUITE # 100 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871202617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058986262 | ||||||||
| FaxNumber: | 5057969601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2017 | ||||||||
| LastUpdateDate: | 01/10/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | WOOD | ||||||||
| AuthorizedOfficialFirstName: | DARLENE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5052031628 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | NM | N | Agencies | Home Health | 253Z00000X | NM | Y | Agencies | In Home Supportive Care |
ID Information
| ID | Type | State | Issuer | Description | COM-2016-342649 | 01 | NM | BUSINESS | OTHER |