Provider Demographics
NPI:1336809714
Name:ICARE RESIDENTIAL
Entity Type:Organization
Organization Name:ICARE RESIDENTIAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:MICHELAE
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-602-9700
Mailing Address - Street 1:9165 OTIS AVE STE 233
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46216-2317
Mailing Address - Country:US
Mailing Address - Phone:317-602-9700
Mailing Address - Fax:
Practice Address - Street 1:9165 OTIS AVE STE 233
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216-2317
Practice Address - Country:US
Practice Address - Phone:317-602-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services