MEDICARE: THERACARE OF NEW JERSEY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679619126
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERACARE OF NEW JERSEY LLC

Provider Business Mailing Address
First Line	:	6981 N PARK DR
Second Line	:	WEST BUILDING SUITE 504
City	:	PENNSAUKEN
State	:	NJ
Zip	:	08109-4205
Country	:	US
Telephone Number	:	800-393-1306
Fax Number	:

Provider Business Practice Location Address
First Line	:	6981 N PARK DR
Second Line	:	WEST BUILDING SUITE 504
City	:	PENNSAUKEN
State	:	NJ
Zip	:	08109-4205
Country	:	US
Telephone Number	:	800-393-1306
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN CALDERON
Credential	:
Telephone Number	:	212-564-2350

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	08/22/2020

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