Provider Demographics
NPI:1447512934
Name:THERACARE
Entity type:Organization
Organization Name:THERACARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPECIAL ED. TEACHER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLOTA
Authorized Official - Middle Name:POWELL
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:II
Authorized Official - Credentials:SPECIAL ED TEACHER
Authorized Official - Phone:347-856-2646
Mailing Address - Street 1:171 RANDOLPH AVE
Mailing Address - Street 2:171 RANDOLPH AVE
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-4416
Mailing Address - Country:US
Mailing Address - Phone:347-856-2646
Mailing Address - Fax:
Practice Address - Street 1:171 RANDOLPH AVE
Practice Address - Street 2:171 RANDOLPH AVE
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-4416
Practice Address - Country:US
Practice Address - Phone:347-856-2646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY56062252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency