Provider Demographics
NPI:1518640085
Name:ICARE TELECARE PLLC
Entity Type:Organization
Organization Name:ICARE TELECARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN-CNS/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAFF
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:208-340-0622
Mailing Address - Street 1:PO BOX 226
Mailing Address - Street 2:
Mailing Address - City:BUHL
Mailing Address - State:ID
Mailing Address - Zip Code:83316-0226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:784 S CLEARWATER LOOP STE F
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-9599
Practice Address - Country:US
Practice Address - Phone:208-918-2473
Practice Address - Fax:866-936-5762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service