Provider Demographics
NPI:1982028023
Name:ICON HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:ICON HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FARAHLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRACKEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:832-930-9500
Mailing Address - Street 1:5829 W SAM HOUSTON PKWY N STE 1109
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-4743
Mailing Address - Country:US
Mailing Address - Phone:832-930-9500
Mailing Address - Fax:832-930-9397
Practice Address - Street 1:5829 W SAM HOUSTON PKWY N STE 1109
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041-4743
Practice Address - Country:US
Practice Address - Phone:832-930-9500
Practice Address - Fax:832-930-9397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health