Provider Demographics
NPI:1740900729
Name:ICARE PRACTITIONERS AND NURSING CONCIERGE INC
Entity type:Organization
Organization Name:ICARE PRACTITIONERS AND NURSING CONCIERGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:DR
Authorized Official - First Name:RERHIME
Authorized Official - Middle Name:RERI
Authorized Official - Last Name:UKU
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:909-701-8649
Mailing Address - Street 1:9655 MONTE VISTA AVE STE 402A
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2238
Mailing Address - Country:US
Mailing Address - Phone:909-701-8649
Mailing Address - Fax:
Practice Address - Street 1:9655 MONTE VISTA AVE STE 402A
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2238
Practice Address - Country:US
Practice Address - Phone:909-701-8649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-31
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty