Provider Demographics
NPI:1861047904
Name:INDEPENDENT CARE AGENCY
Entity type:Organization
Organization Name:INDEPENDENT CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:815-701-8389
Mailing Address - Street 1:322 CANYON VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-1934
Mailing Address - Country:US
Mailing Address - Phone:815-701-8389
Mailing Address - Fax:224-206-8672
Practice Address - Street 1:888 S GREENVILLE AVE STE 207
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5044
Practice Address - Country:US
Practice Address - Phone:815-701-8389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care