Provider Demographics
NPI:1316290307
Name:ICARE MEDICAL STAFFING, INC.
Entity type:Organization
Organization Name:ICARE MEDICAL STAFFING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AYANNA
Authorized Official - Middle Name:ROXANNE
Authorized Official - Last Name:SUTHERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-444-5828
Mailing Address - Street 1:4440 PGA BOULEVARD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6539
Mailing Address - Country:US
Mailing Address - Phone:561-444-5828
Mailing Address - Fax:
Practice Address - Street 1:4440 PGA BOULEVARD
Practice Address - Street 2:SUITE 600
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-6539
Practice Address - Country:US
Practice Address - Phone:561-444-5828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL385H00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care