Provider Demographics
NPI:1588323190
Name:ICARE RESIDENTIAL AND COMMUNITY SERVICES
Entity type:Organization
Organization Name:ICARE RESIDENTIAL AND COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-825-3514
Mailing Address - Street 1:5962 ZEBULON RD STE 329
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-2099
Mailing Address - Country:US
Mailing Address - Phone:478-335-6962
Mailing Address - Fax:
Practice Address - Street 1:129 MONTROSE DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31220-2662
Practice Address - Country:US
Practice Address - Phone:478-335-6962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health