Provider Demographics
NPI:1588467278
Name:ICARE TOTAL HEALTH SERVICES, INC
Entity type:Organization
Organization Name:ICARE TOTAL HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:R JUSTICE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAIMAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-515-4874
Mailing Address - Street 1:14050 N 83RD AVE STE 290
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5650
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30175 W FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85396-2184
Practice Address - Country:US
Practice Address - Phone:402-515-4874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ICARE TOTAL HEALTH SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-29
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities