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General NPI Number Information
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NPI Number | 1366382541
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Entity Type | Organization
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Legal Business Name | IMMIGRANT COMMUNITY DEVELOPMENT CENTER INC
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Dates
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Enumeration Date | 03/30/2026
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Last Update Date | 03/30/2026
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Provider Practice Location Address
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Address Line | 299 CAREW ST STE 134
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City | SPRINGFIELD
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State | MA
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Zip | 01104-2361
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Country | US
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Telephone | 413-291-9020
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Fax |
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Provider Business Mailing Address
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Address Line | 26 BEAUDRY ST
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City | INDIAN ORCHARD
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State | MA
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Zip | 01151-1704
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Country | US
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Telephone | 413-291-9020
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | RAWAN EBRAHIM
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Credential | REGISTER NURSE
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Telephone | 413-291-9020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LX0106X
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Taxonomy Name | Occupational Health Nurse Practitioner
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License Number |
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License Number State |
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