Healthcare Provider Details

I. General information

NPI: 1376856351
Provider Name (Legal Business Name): THERACARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 WEST 32ND ST
NEW YORK NY
10001
US

IV. Provider business mailing address

116 WEST 32ND ST
NEW YORK NY
10001
US

V. Phone/Fax

Practice location:
  • Phone: 212-564-2350
  • Fax: 212-947-7625
Mailing address:
  • Phone: 866-551-9700
  • Fax: 212-947-7625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARCELLO KEITH WRIGHT JR.
Title or Position: STAFFING
Credential:
Phone: 866-551-9700