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General NPI Number Information
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NPI Number | 1003494311
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Entity Type | Organization
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Legal Business Name | THE ICAN MULTI SERVICE GROUP LLC
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Dates
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Enumeration Date | 03/30/2021
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Last Update Date | 05/11/2022
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Provider Practice Location Address
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Address Line | 3350 E ATLANTIC BLVD STE 209
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City | POMPANO BEACH
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State | FL
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Zip | 33062-5743
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Country | US
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Telephone | 954-258-3714
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Fax |
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Provider Business Mailing Address
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Address Line | 1950 NE 6TH ST UNIT 2324
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City | POMPANO BEACH
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State | FL
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Zip | 33061-2614
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Country | US
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Telephone | 954-951-7899
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LATRICA M CHANCE
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Credential | CNA FINIACE OFFICE
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Telephone | 954-258-3714
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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