MEDICARE: I CAN'T - WE CAN, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	903036	MD

General Provider Information

NPI Number	:	1801948070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	I CAN'T - WE CAN, INC.

Provider Business Mailing Address
First Line	:	PO BOX 67160
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-0042
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4432 PARK HEIGHTS AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21215-6324
Country	:	US
Telephone Number	:	410-466-8833
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. ISRAEL CASON
Credential	:	CAC-AD
Telephone Number	:	410-466-8833

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/25/2007

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