Provider Demographics
NPI:1932859600
Name:ICAN HEALTH CARE & SERVICES LLC
Entity type:Organization
Organization Name:ICAN HEALTH CARE & SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COE/CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ISAIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-622-2618
Mailing Address - Street 1:4225 W GLENDALE AVE
Mailing Address - Street 2:STE A-100/101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-8194
Mailing Address - Country:US
Mailing Address - Phone:480-851-8323
Mailing Address - Fax:
Practice Address - Street 1:4225 W GLENDALE AVE
Practice Address - Street 2:SUITE A-100/101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-8194
Practice Address - Country:US
Practice Address - Phone:480-851-8323
Practice Address - Fax:623-207-9564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-25
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health