Provider Demographics
NPI:1972329597
Name:ICARE HEALTH SERVICES LLC
Entity type:Organization
Organization Name:ICARE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FABULUJE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-717-2541
Mailing Address - Street 1:10851 N BLACK CANYON HWY STE 700
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4788
Mailing Address - Country:US
Mailing Address - Phone:202-717-2541
Mailing Address - Fax:
Practice Address - Street 1:11464 E DRY WIND DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-2002
Practice Address - Country:US
Practice Address - Phone:520-867-9187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health