| Organization Name: | ICARE SUPPORTED LIVING, INC. |
| NPI Number: | 1083026579 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CARI RENEE GILBERT (OWNER/ ADMINISTRATOR/ QIDP) |
| Mailing Address: | 1903 N Windsor Park Ave Middleton |
| State: | ID US |
| Postal Code: | 836445584 |
| Phone Number: | 2086953505 |
| Fax Number: | 2089554130 |
| NPI Enumeration Date: | 06/02/2014 |
| NPI Last Update Date: | 06/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | RHA-5220 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |