Healthcare Provider Details

I. General information

NPI: 1497659973
Provider Name (Legal Business Name): ICARE COMPLETE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4732 N 86TH DR
PHOENIX AZ
85037-1230
US

IV. Provider business mailing address

4409 N 179TH DR
GOODYEAR AZ
85395-5201
US

V. Phone/Fax

Practice location:
  • Phone: 623-229-4755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: MONIQUE MASON
Title or Position: EXECUTIVE DIRECTOR/OWNER
Credential:
Phone: 623-229-4755