Basic Information
| Provider Information | |||||||||
| NPI: | 1184916496 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERCARE THERAPY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4221 WILSHIRE BLVD STE 300A | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900103537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238661880 | ||||||||
| FaxNumber: | 3238661881 | ||||||||
| Practice Location | |||||||||
| Address1: | 4221 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900103512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238661880 | ||||||||
| FaxNumber: | 3238661881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2011 | ||||||||
| LastUpdateDate: | 08/12/2021 | ||||||||
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| AuthorizedOfficialLastName: | HELLER | ||||||||
| AuthorizedOfficialFirstName: | ARNON | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT, C.E.O. | ||||||||
| AuthorizedOfficialTelephone: | 3238661880 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSY.D. | ||||||||
| NPICertificationDate: | 08/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251C00000X | CA | N | Agencies | Day Training, Developmentally Disabled Services | 252Y00000X | N | Agencies | Early Intervention Provider Agency | 251S00000X | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.