Provider Demographics
NPI:1861882771
Name:THERACARE
Entity type:Organization
Organization Name:THERACARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RN SCHOOL
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:N/A
Authorized Official - Last Name:SEVERE
Authorized Official - Suffix:
Authorized Official - Credentials:NURSING
Authorized Official - Phone:212-564-2350
Mailing Address - Street 1:15 MILL ST APT 2E
Mailing Address - Street 2:N/A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-2511
Mailing Address - Country:US
Mailing Address - Phone:347-948-9851
Mailing Address - Fax:347-948-9851
Practice Address - Street 1:15 MILL ST APT 2E
Practice Address - Street 2:N/A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-2511
Practice Address - Country:US
Practice Address - Phone:347-948-1848
Practice Address - Fax:347-948-1848
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THERACARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY436790-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health