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General NPI Number Information
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NPI Number | 1306285499
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Entity Type | Organization
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Legal Business Name | THERACARE
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Dates
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Enumeration Date | 06/21/2013
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Last Update Date | 06/21/2013
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Provider Practice Location Address
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Address Line | 9777 QUEENS BLVD PENTHOUSE
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City | REGO PARK
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State | NY
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Zip | 11374-3335
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Country | US
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Telephone | 718-830-9274
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Fax | 718-228-7829
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Provider Business Mailing Address
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Address Line | 9777 QUEENS BLVD PENTHOUSE
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City | REGO PARK
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State | NY
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Zip | 11374-3335
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Country | US
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Telephone | 718-830-9274
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Fax | 718-228-7829
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Authorized Official
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Title or Position | SPECIAL EDUCATOR
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Name | JESSICA SANCHEZ
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Credential | M.S. SPED
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Telephone | 718-830-9274
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 370785091
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License Number State | NY
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