Provider Demographics
NPI:1003494311
Name:THE ICAN MULTI SERVICE GROUP LLC
Entity Type:Organization
Organization Name:THE ICAN MULTI SERVICE GROUP LLC
Other - Org Name:ICAN HEALTHCARE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATRICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHANCE
Authorized Official - Suffix:
Authorized Official - Credentials:CNA FINIACE OFFICE
Authorized Official - Phone:954-258-3714
Mailing Address - Street 1:1950 NE 6TH ST UNIT 2324
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33061-2614
Mailing Address - Country:US
Mailing Address - Phone:954-951-7899
Mailing Address - Fax:
Practice Address - Street 1:3350 E ATLANTIC BLVD STE 209
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-5743
Practice Address - Country:US
Practice Address - Phone:954-258-3714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-30
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate VehicleGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110775100Medicaid