Provider Demographics
NPI:1700403011
Name:ICARE HEALTH & WELLNESS MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:ICARE HEALTH & WELLNESS MEDICAL CENTER, LLC
Other - Org Name:ICARE BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZAINAB
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-896-8100
Mailing Address - Street 1:3242 E MAIN ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-3807
Mailing Address - Country:US
Mailing Address - Phone:614-500-4150
Mailing Address - Fax:614-500-4160
Practice Address - Street 1:3242 E MAIN ST
Practice Address - Street 2:2ND FL
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-3807
Practice Address - Country:US
Practice Address - Phone:614-500-4150
Practice Address - Fax:614-500-4160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-02
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0406086Medicaid