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General NPI Number Information
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NPI Number | 1790188902
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Entity Type | Organization
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Legal Business Name | I-KARE TREATMENT CENTER, LLC
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Dates
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Enumeration Date | 10/01/2014
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 1720 E TIFFANY DR STE 101
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City | MANGONIA PARK
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State | FL
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Zip | 33407-3235
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Country | US
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Telephone | 561-331-8453
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Fax | 954-208-0462
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Provider Business Mailing Address
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Address Line | 1720 E TIFFANY DR STE 101
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City | MANGONIA PARK
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State | FL
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Zip | 33407-3235
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Country | US
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Telephone | 561-331-8453
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Fax | 954-208-0462
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Authorized Official
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Title or Position | COO
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Name | NICHOLE GARY
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Credential | NCRC, NCCM, B.S(PSY)
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Telephone | 561-331-8453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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