Provider Demographics
NPI:1891105219
Name:THERACARE, INC.
Entity type:Organization
Organization Name:THERACARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-830-9274
Mailing Address - Street 1:9777 QUEENS BLVD PH
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3300
Mailing Address - Country:US
Mailing Address - Phone:718-830-9274
Mailing Address - Fax:718-830-9276
Practice Address - Street 1:9777 QUEENS BLVD PH
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3300
Practice Address - Country:US
Practice Address - Phone:718-830-9274
Practice Address - Fax:718-830-9276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency