Healthcare Provider Details

I. General information

NPI: 1831509264
Provider Name (Legal Business Name): THERACARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 MEMORIAL DR SUITE 2
MANCHESTER KY
40962-9156
US

IV. Provider business mailing address

485 MEMORIAL DR SUITE 2
MANCHESTER KY
40962-9156
US

V. Phone/Fax

Practice location:
  • Phone: 606-599-1709
  • Fax: 606-599-8549
Mailing address:
  • Phone: 606-599-1709
  • Fax: 606-599-8549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberRO334
License Number StateKY

VIII. Authorized Official

Name: MRS. LESLIE M SIZEMORE
Title or Position: PRESIDENT
Credential: ED.S, OTR/L
Phone: 606-599-1709