Provider Demographics
NPI:1962195487
Name:ICONQUER COMMUNITY HEALTH SERVICES LLC
Entity type:Organization
Organization Name:ICONQUER COMMUNITY HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TOLES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:614-636-1986
Mailing Address - Street 1:173 SYCAMORE LN
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-7567
Mailing Address - Country:US
Mailing Address - Phone:614-636-1986
Mailing Address - Fax:
Practice Address - Street 1:173 SYCAMORE LN
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-7567
Practice Address - Country:US
Practice Address - Phone:614-636-1986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health