Provider Demographics
NPI:1932798931
Name:ICARE HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:ICARE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE PROGRAM DIRECTOR/ADMINIST
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FABULUJE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-548-7433
Mailing Address - Street 1:3006 W DONNER DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-6345
Mailing Address - Country:US
Mailing Address - Phone:708-953-5513
Mailing Address - Fax:
Practice Address - Street 1:5802 S 53RD LN
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-2412
Practice Address - Country:US
Practice Address - Phone:480-548-7433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health