Provider Demographics
NPI:1679773865
Name:I CAN'T - WE CAN, INC.
Entity type:Organization
Organization Name:I CAN'T - WE CAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:CASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-728-4491
Mailing Address - Street 1:4426 PARK HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-6324
Mailing Address - Country:US
Mailing Address - Phone:410-728-4491
Mailing Address - Fax:
Practice Address - Street 1:4432B PARK HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-6324
Practice Address - Country:US
Practice Address - Phone:410-728-4491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD903261324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4115988 00Medicaid