Provider Demographics
NPI:1659961761
Name:ICONIX HEALTHCARE LLC
Entity Type:Organization
Organization Name:ICONIX HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-770-3741
Mailing Address - Street 1:1830 S OCEAN DR APT 4608
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-7717
Mailing Address - Country:US
Mailing Address - Phone:310-770-3741
Mailing Address - Fax:
Practice Address - Street 1:1830 S OCEAN DR APT 4608
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-7717
Practice Address - Country:US
Practice Address - Phone:310-770-3741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care