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General NPI Number Information
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NPI Number | 1679745913
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Entity Type | Organization
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Legal Business Name | TERAPRO. CARE
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 2717 SCHLEIGEL BLVD
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City | AMITYVILLE
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State | NY
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Zip | 11701-1345
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Country | US
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Telephone | 718-404-2185
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 30088
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City | BROOKLYN
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State | NY
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Zip | 11203-0088
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Country | US
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Telephone | 718-404-2185
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Fax |
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Authorized Official
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Title or Position | SENIOR OCCUPATIONAL THERAPIST
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Name | MR. CARLOS ANTONIO BENT
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Credential |
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Telephone | 718-249-5884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 0089371
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License Number State | NY
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