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General NPI Number Information
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NPI Number | 1720309651
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC LOVING CARE
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Dates
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Enumeration Date | 06/15/2010
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Last Update Date | 06/15/2010
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Provider Practice Location Address
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Address Line | 11 SALVATORE DR
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5898
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Country | US
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Telephone | 732-670-2039
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Fax |
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Provider Business Mailing Address
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Address Line | 11 SALVATORE DR
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5898
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Country | US
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Telephone | 732-670-2039
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TEMEKIA DONALD
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Credential |
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Telephone | 732-670-2039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 46TR00278800
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License Number State | NJ
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