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General NPI Number Information
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NPI Number | 1083026579
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Entity Type | Organization
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Legal Business Name | ICARE SUPPORTED LIVING, INC.
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Dates
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Enumeration Date | 06/02/2014
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 1903 N WINDSOR PARK AVE
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City | MIDDLETON
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State | ID
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Zip | 83644-5584
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Country | US
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Telephone | 208-695-3505
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Fax | 208-955-4130
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Provider Business Mailing Address
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Address Line | 1903 N WINDSOR PARK AVE
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City | MIDDLETON
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State | ID
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Zip | 83644-5584
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Country | US
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Telephone | 208-695-3505
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Fax | 208-955-4130
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Authorized Official
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Title or Position | OWNER/ ADMINISTRATOR/ QIDP
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Name | MRS. CARI RENEE GILBERT
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Credential | B.S.W.
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Telephone | 208-695-3505
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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 | RHA-5220
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License Number State | ID
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