MEDICARE: ICAN HEALTH CARE & SERVICES LLC

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	:	1932859600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ICAN HEALTH CARE & SERVICES LLC

Provider Business Mailing Address
First Line	:	4225 W GLENDALE AVE
Second Line	:	STE A-100/101
City	:	PHOENIX
State	:	AZ
Zip	:	85051-8194
Country	:	US
Telephone Number	:	480-851-8323
Fax Number	:

Provider Business Practice Location Address
First Line	:	4225 W GLENDALE AVE
Second Line	:	SUITE A-100/101
City	:	PHOENIX
State	:	AZ
Zip	:	85051-8194
Country	:	US
Telephone Number	:	480-851-8323
Fax Number	:	623-207-9564

Authorized Official
Title or Position	:	COE/CO-OWNER
Name	:	MR. ISAIAH BANKOLE
Credential	:
Telephone Number	:	602-622-2618

Provider Enumeration Date	:	03/25/2022
Last Update Date	:	11/10/2022

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Directions to “ICAN HEALTH CARE & SERVICES LLC ” Practice Location

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