Healthcare Provider Details

I. General information

NPI: 1013666304
Provider Name (Legal Business Name): ICAN GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 E ORCHID LN
CHANDLER AZ
85225-1406
US

IV. Provider business mailing address

PO BOX 11716
TEMPE AZ
85284-0029
US

V. Phone/Fax

Practice location:
  • Phone: 480-267-0358
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MOHAMED IMAM
Title or Position: MANAGER
Credential: PHD
Phone: 480-267-0358