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General NPI Number Information
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NPI Number | 1609494293
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Entity Type | Organization
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Legal Business Name | I CARE DOMETIC VIOLENCE AGAINST MEN INC
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Dates
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Enumeration Date | 07/09/2020
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Last Update Date | 07/09/2020
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Provider Practice Location Address
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Address Line | 13080 SW 248TH ST
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City | HOMESTEAD
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State | FL
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Zip | 33032-5706
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Country | US
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Telephone | 954-770-9837
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Fax |
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Provider Business Mailing Address
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Address Line | 24601 SW 137TH DAY AVE
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City | HOMESTEAD
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State | FL
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Zip | 33032
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Country | US
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Telephone | 954-700-9837
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TERRANCE MOORE
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Credential |
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Telephone | 954-700-9837
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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