Healthcare Provider Details

I. General information

NPI: 1659633071
Provider Name (Legal Business Name): THERACARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CEDAR ST
NEW ROCHELLE NY
10801-5247
US

IV. Provider business mailing address

71 HEIGHTS DR
YONKERS NY
10710-2401
US

V. Phone/Fax

Practice location:
  • Phone: 914-576-5292
  • Fax:
Mailing address:
  • Phone: 914-439-3785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNY

VIII. Authorized Official

Name: MICHELLE BANOME
Title or Position: SPECIAL ED TEACHER
Credential:
Phone: 914-439-3785