| Icarus House Llc. | |
|
23832 W Tonto St Buckeye AZ 85326-8139 | |
| (310) 621-2776 | |
| Not Available |
| Full Name | Icarus House Llc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 23832 W Tonto St, Buckeye, Arizona |
| Authorized Official Name and Position | Donatus Agbakwu (CEO/MANGER) |
| Authorized Official Contact | 3106212776 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Icarus House Llc. 1721 W Magdalena Ln Phoenix AZ 85041-7814 Ph: (310) 621-2776 | Icarus House Llc. 23832 W Tonto St Buckeye AZ 85326-8139 Ph: (310) 621-2776 |
| NPI Number | 1164288809 |
|---|---|
| Provider Enumeration Date | 02/21/2024 |
| Last Update Date | 02/21/2024 |
| Certification Date | 02/21/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164288809 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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