Provider Demographics
NPI:1700143609
Name:ICARE AMBULANCE LLC
Entity Type:Organization
Organization Name:ICARE AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-IV
Authorized Official - Phone:888-422-7312
Mailing Address - Street 1:PO BOX 5361
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5361
Mailing Address - Country:US
Mailing Address - Phone:888-422-7312
Mailing Address - Fax:888-422-7312
Practice Address - Street 1:7375 S PEORIA ST STE 214
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-4157
Practice Address - Country:US
Practice Address - Phone:720-459-8460
Practice Address - Fax:888-422-9675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18353416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18326749Medicaid