Provider Demographics
NPI:1386623155
Name:THERACARE INC
Entity type:Organization
Organization Name:THERACARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REIMBURSEMENT MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:RENA
Authorized Official - Last Name:RENNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-965-0816
Mailing Address - Street 1:535 OFFICENTER PL
Mailing Address - Street 2:SUITE C
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230
Mailing Address - Country:US
Mailing Address - Phone:614-471-0036
Mailing Address - Fax:614-471-0087
Practice Address - Street 1:535 OFFICENTER PL
Practice Address - Street 2:SUITE C
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230
Practice Address - Country:US
Practice Address - Phone:614-471-0036
Practice Address - Fax:614-471-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2133551Medicaid
OH=========00OtherWORKERS COMP
366687Medicare ID - Type Unspecified