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General NPI Number Information
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NPI Number | 1588467278
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Entity Type | Organization
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Legal Business Name | ICARE TOTAL HEALTH SERVICES, INC
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Dates
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Enumeration Date | 03/29/2025
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Last Update Date | 03/29/2025
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Provider Practice Location Address
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Address Line | 30175 W FAIRMOUNT AVE
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City | BUCKEYE
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State | AZ
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Zip | 85396-2184
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Country | US
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Telephone | 402-515-4874
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Fax |
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Provider Business Mailing Address
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Address Line | 14050 N 83RD AVE STE 290
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City | PEORIA
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State | AZ
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Zip | 85381-5650
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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 | PRESIDENT
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Name | DR. R JUSTICE BRAIMAH
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Credential |
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Telephone | 402-515-4874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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