Provider Demographics
NPI: | 1518445618 |
---|---|
Name: | ICARE BEHAVIOR SERVICES, LLC |
Entity Type: | Organization |
Organization Name: | ICARE BEHAVIOR SERVICES, LLC |
Other - Org Name: | ICARE WELLNESS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JASMINE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BLANCO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 305-468-9899 |
Mailing Address - Street 1: | 7801 NW 37TH ST STE LP201 |
Mailing Address - Street 2: | |
Mailing Address - City: | DORAL |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33195-6503 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 305-468-9899 |
Mailing Address - Fax: | 305-228-4993 |
Practice Address - Street 1: | 7801 NW 37TH ST STE LP201 |
Practice Address - Street 2: | |
Practice Address - City: | DORAL |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33195-6503 |
Practice Address - Country: | US |
Practice Address - Phone: | 786-291-2858 |
Practice Address - Fax: | 305-228-4993 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-07-31 |
Last Update Date: | 2023-04-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 251E00000X | Agencies | Home Health | Group - Multi-Specialty | |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
No | 106E00000X | Behavioral Health & Social Service Providers | Assistant Behavior Analyst | Group - Multi-Specialty | |
No | 106S00000X | Behavioral Health & Social Service Providers | Behavior Technician | Group - Multi-Specialty | |
No | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
No | 252Y00000X | Agencies | Early Intervention Provider Agency | Group - Multi-Specialty | |
No | 253Z00000X | Agencies | In Home Supportive Care | Group - Multi-Specialty | |
No | 311500000X | Nursing & Custodial Care Facilities | Alzheimer Center (Dementia Center) | Group - Multi-Specialty | |
No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | Group - Multi-Specialty | |
No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | ||
No | 385H00000X | Respite Care Facility | Respite Care | ||
No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child | Group - Multi-Specialty |
No | 385HR2065X | Respite Care Facility | Respite Care | Respite Care, Physical Disabilities, Child | Group - Multi-Specialty |