Icarus House LLC.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

ICARUS HOUSE LLC.

Practice address

23832 W Tonto St
Buckeye, AZ 85326-8139

Phone

(310) 621-2776

NPI assigned

Feb 21, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Donatus Agbakwu

Title

Ceo/Manger

Phone

(310) 621-2776

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1708473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708473600000",
    "number": "1164288809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1721 W MAGDALENA LN",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850417814",
            "telephone_number": "310-621-2776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23832 W TONTO ST",
            "city": "BUCKEYE",
            "state": "AZ",
            "postal_code": "853268139",
            "telephone_number": "310-621-2776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICARUS HOUSE LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-21",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A",
        "authorized_official_last_name": "AGBAKWU",
        "authorized_official_first_name": "DONATUS",
        "authorized_official_title_or_position": "CEO/MANGER",
        "authorized_official_telephone_number": "310-621-2776"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Buckeye, AZ by specialty
• Community/Behavioral Health Agency in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.