Provider Demographics
NPI:1164072815
Name:ICBEYOND HOLDINGS, INC.
Entity Type:Organization
Organization Name:ICBEYOND HOLDINGS, INC.
Other - Org Name:ICBEYOND CHILDREN & FAMILY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ISIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSSO
Authorized Official - Suffix:
Authorized Official - Credentials:MSED, ITDS
Authorized Official - Phone:561-827-7336
Mailing Address - Street 1:2200 NW CORPORATE BLVD STE 407
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7369
Mailing Address - Country:US
Mailing Address - Phone:561-827-7336
Mailing Address - Fax:270-738-5243
Practice Address - Street 1:9024 CARMA DR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-1269
Practice Address - Country:US
Practice Address - Phone:561-827-7336
Practice Address - Fax:270-738-5243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-15
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty