MEDICARE: ICY ROOKS

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	3747P1801X	Personal Care Attendant
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1447679006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ICY ROOKS

Provider Business Mailing Address
First Line	:	915 ROYALMILE WAY
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-9001
Country	:	US
Telephone Number	:	702-945-5208
Fax Number	:	702-586-6645

Provider Business Practice Location Address
First Line	:	915 ROYALMILE WAY
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-9001
Country	:	US
Telephone Number	:	702-945-5208
Fax Number	:	702-586-6645

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2014
Last Update Date	:	08/07/2024

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Directions to “ ICY ROOKS ” Practice Location

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