Healthcare Provider Details

I. General information

NPI: 1164072815
Provider Name (Legal Business Name): ICBEYOND HOLDINGS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2019
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9024 CARMA DR
BOYNTON BEACH FL
33472-1269
US

IV. Provider business mailing address

2200 NW CORPORATE BLVD STE 407
BOCA RATON FL
33431-7369
US

V. Phone/Fax

Practice location:
  • Phone: 561-827-7336
  • Fax: 270-738-5243
Mailing address:
  • Phone: 561-827-7336
  • Fax: 270-738-5243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ISIS ROSSO
Title or Position: OWNER
Credential: M.S.ED., ITDS
Phone: 561-827-7336