MEDICARE: ICARE MANAGEMENT SERVICES 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	251X00000X	Supports Brokerage Agency

General Provider Information

NPI Number	:	1477946671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ICARE MANAGEMENT SERVICES INC

Provider Business Mailing Address
First Line	:	1111 W ROBINHOOD DR
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-5626
Country	:	US
Telephone Number	:	209-406-6610
Fax Number	:	209-451-4997

Provider Business Practice Location Address
First Line	:	1111 W ROBINHOOD DR
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-5626
Country	:	US
Telephone Number	:	209-406-6610
Fax Number	:	209-451-4997

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PRAXEDES B DEMESA
Credential	:	MPA, NHA, BSMT
Telephone Number	:	209-406-6610

Provider Enumeration Date	:	03/12/2015
Last Update Date	:	03/12/2015

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