Provider Demographics
NPI:1992159214
Name:ICARE NURSING SERVICES
Entity type:Organization
Organization Name:ICARE NURSING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-691-0116
Mailing Address - Street 1:3691 PALMETTO POINTE BLVD
Mailing Address - Street 2:SUITE 302-B
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-1202
Mailing Address - Country:US
Mailing Address - Phone:843-691-0116
Mailing Address - Fax:843-831-0278
Practice Address - Street 1:3691 PALMETTO POINTE BLVD
Practice Address - Street 2:SUITE 302-B
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-1202
Practice Address - Country:US
Practice Address - Phone:843-691-0116
Practice Address - Fax:843-831-0278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC227780Medicaid