Healthcare Provider Details

I. General information

NPI: 1003494311
Provider Name (Legal Business Name): THE ICAN MULTI SERVICE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 E ATLANTIC BLVD STE 209
POMPANO BEACH FL
33062-5743
US

IV. Provider business mailing address

1950 NE 6TH ST UNIT 2324
POMPANO BEACH FL
33061-2614
US

V. Phone/Fax

Practice location:
  • Phone: 954-258-3714
  • Fax:
Mailing address:
  • Phone: 954-951-7899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: LATRICA M CHANCE
Title or Position: OWNER
Credential: CNA FINIACE OFFICE
Phone: 954-258-3714