Provider Demographics
NPI:1194075259
Name:KATHRYN HANNAN AT THERACARE, INC
Entity type:Organization
Organization Name:KATHRYN HANNAN AT THERACARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:HANNAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:734-332-3800
Mailing Address - Street 1:2002 HOGBACK RD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9736
Mailing Address - Country:US
Mailing Address - Phone:734-332-3800
Mailing Address - Fax:734-707-0606
Practice Address - Street 1:2002 HOGBACK RD
Practice Address - Street 2:SUITE 14
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9736
Practice Address - Country:US
Practice Address - Phone:734-332-3800
Practice Address - Fax:734-707-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center