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General NPI Number Information
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NPI Number | 1851973069
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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 | 04/27/2021
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Last Update Date | 08/02/2024
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Provider Practice Location 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 | 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 | 402-515-4874
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. R JUSTICE BRAIMAH
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Credential | PHD
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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 | 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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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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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 | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #6
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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 #7
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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