MEDICARE: INTERCARE THERAPY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1164065892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERCARE THERAPY INC.

Provider Business Mailing Address
First Line	:	4221 WILSHIRE BLVD STE 300A
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3537
Country	:	US
Telephone Number	:	888-428-3223
Fax Number	:	323-866-1881

Provider Business Practice Location Address
First Line	:	6851 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1600
Country	:	US
Telephone Number	:	888-428-3223
Fax Number	:	323-866-1881

Authorized Official
Title or Position	:	PAYOR RELATIONS SPECIALIST
Name	:	JONATHAN TAIMAN
Credential	:
Telephone Number	:	888-428-3223

Provider Enumeration Date	:	10/25/2019
Last Update Date	:	10/06/2023

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