Provider Demographics
NPI:1700572724
Name:ICARE BEHAVIOR SERVICES, LLC
Entity Type:Organization
Organization Name:ICARE BEHAVIOR SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-291-2858
Mailing Address - Street 1:7801 NW 37TH ST STE LP-201
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33195-6503
Mailing Address - Country:US
Mailing Address - Phone:305-468-9899
Mailing Address - Fax:
Practice Address - Street 1:7801 NW 37TH ST STE LP-201
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33195-6503
Practice Address - Country:US
Practice Address - Phone:305-468-9899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health