Provider Demographics
NPI:1679219679
Name:ICONS BEHAVIORAL NURSING CARE INC
Entity Type:Organization
Organization Name:ICONS BEHAVIORAL NURSING CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIIONER
Authorized Official - Prefix:
Authorized Official - First Name:BERNICE
Authorized Official - Middle Name:CHINYERE
Authorized Official - Last Name:IVOKO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:951-314-3088
Mailing Address - Street 1:9087 ARROW RTE STE 265
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-4487
Mailing Address - Country:US
Mailing Address - Phone:562-824-5099
Mailing Address - Fax:
Practice Address - Street 1:9087 ARROW RTE STE 265
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4487
Practice Address - Country:US
Practice Address - Phone:562-824-5099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty