Provider Demographics
NPI:1245997030
Name:ICARE ADULT DAY CENTER, LLC
Entity type:Organization
Organization Name:ICARE ADULT DAY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WIKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-515-1011
Mailing Address - Street 1:213 N MARINA ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-3105
Mailing Address - Country:US
Mailing Address - Phone:928-515-1011
Mailing Address - Fax:
Practice Address - Street 1:213 N MARINA ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-3105
Practice Address - Country:US
Practice Address - Phone:928-515-1011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care