Provider Demographics
NPI:1376723973
Name:ICARE MANOR, INC.
Entity Type:Organization
Organization Name:ICARE MANOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIEP
Authorized Official - Middle Name:D
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-957-8385
Mailing Address - Street 1:15 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95113-1207
Mailing Address - Country:US
Mailing Address - Phone:408-287-5262
Mailing Address - Fax:408-287-1597
Practice Address - Street 1:1215 W SWAIN RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-4228
Practice Address - Country:US
Practice Address - Phone:209-957-8385
Practice Address - Fax:209-477-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility