Healthcare Provider Details

I. General information

NPI: 1326559865
Provider Name (Legal Business Name): I-CARE RIDES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 05/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2902 RENICK ST
SAINT JOSEPH MO
64507-1840
US

IV. Provider business mailing address

2902 RENICK ST
SAINT JOSEPH MO
64507-1840
US

V. Phone/Fax

Practice location:
  • Phone: 816-344-4469
  • Fax: 816-364-0054
Mailing address:
  • Phone: 816-344-4469
  • Fax: 816-364-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA M JOHNSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 816-344-4469