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General NPI Number Information
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NPI Number | 1518640085
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Entity Type | Organization
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Legal Business Name | ICARE TELECARE PLLC
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Dates
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Enumeration Date | 08/10/2023
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Last Update Date | 08/10/2023
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Provider Practice Location Address
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Address Line | 784 S CLEARWATER LOOP STE F
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City | POST FALLS
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State | ID
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Zip | 83854-9599
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Country | US
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Telephone | 208-918-2473
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Fax | 866-936-5762
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Provider Business Mailing Address
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Address Line | PO BOX 226
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City | BUHL
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State | ID
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Zip | 83316-0226
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | APRN-CNS/ OWNER
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Name | KELLY GRAFF
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Credential | APRN
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Telephone | 208-340-0622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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