Healthcare Provider Details

I. General information

NPI: 1558834036
Provider Name (Legal Business Name): THERACARE MANAGED SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11-20 46TH ROAD
LONG ISLAND CITY NY
11101
US

IV. Provider business mailing address

116 WEST 32ND ST. 8TH FLR.
NEW YORK NY
10001
US

V. Phone/Fax

Practice location:
  • Phone: 855-681-8555
  • Fax: 914-560-2102
Mailing address:
  • Phone: 212-564-2350
  • Fax: 212-564-2578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN CALDERON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 212-564-2350