Healthcare Provider Details

I. General information

NPI: 1679905178
Provider Name (Legal Business Name): THERACARE COMMUNITY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7481 W OAKLAND PARK BLVD SUITE 302 C
TAMARAC FL
33319-4985
US

IV. Provider business mailing address

5010 SW 19TH ST
WEST PARK FL
33023-3271
US

V. Phone/Fax

Practice location:
  • Phone: 954-256-4601
  • Fax:
Mailing address:
  • Phone: 954-256-4601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberMT 2758
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMT 2758
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberMT 2758
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberMT 2758
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberMT 2758
License Number StateFL

VIII. Authorized Official

Name: MR. WALTER WILLIAM HOWARD
Title or Position: EXECUTIVE DIRECTOR
Credential: M.S., LMFT
Phone: 954-256-4601