Provider Demographics
NPI:1184016032
Name:ICB ENTERPRISES CORPORATION
Entity Type:Organization
Organization Name:ICB ENTERPRISES CORPORATION
Other - Org Name:HOMEWATCH CAREGIVERS OF SOUTHWEST AUSTIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-400-2333
Mailing Address - Street 1:11183 CIRCLE C DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78736
Mailing Address - Country:US
Mailing Address - Phone:512-400-2333
Mailing Address - Fax:512-400-2334
Practice Address - Street 1:11183 CIRCLE DR
Practice Address - Street 2:SUITE C
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78736
Practice Address - Country:US
Practice Address - Phone:512-400-2333
Practice Address - Fax:512-400-2334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
TX016857253Z00000X
TX253Z00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3519480Medicaid