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General NPI Number Information
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NPI Number | 1790051563
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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 | 03/27/2012
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Last Update Date | 03/27/2012
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Provider Practice Location Address
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Address Line | 5356 HOLLY SPRINGS CT
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City | INDIANAPOLIS
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State | IN
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Zip | 46254
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Country | US
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Telephone | 317-757-9384
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Fax |
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Provider Business Mailing Address
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Address Line | 5356 HOLLY SPRINGS CT
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-4284
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Country | US
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Telephone | 317-757-9384
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPY ASSISTANT
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Name | MR. ERIC ROBERT BRYANT
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Credential | COTA
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Telephone | 317-757-9384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 32001792A
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License Number State | IN
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