Basic Information
| Provider Information | |||||||||
| NPI: | 1013286947 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | INTERCARE THERAPY INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4221 WILSHIRE BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900103512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3235563020 | ||||||||
| FaxNumber: | 3238661881 | ||||||||
| Practice Location | |||||||||
| Address1: | 2934 E GARVEY AVE S STE 202 | ||||||||
| Address2: | |||||||||
| City: | WEST COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917912178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8884283223 | ||||||||
| FaxNumber: | 3238661881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2011 | ||||||||
| LastUpdateDate: | 11/26/2018 | ||||||||
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| AuthorizedOfficialLastName: | HELLER | ||||||||
| AuthorizedOfficialFirstName: | ARNON | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3238661880 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | INTERCARE THERAPT INC. | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSY.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251C00000X | N | Agencies | Day Training, Developmentally Disabled Services | 252Y00000X | N | Agencies | Early Intervention Provider Agency | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.