Basic Information
| Provider Information | |||||||||
| NPI: | 1578709994 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THERACARE PRESCHOOL SERVICES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THERACARE INC. | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 116 W 32ND ST | ||||||||
| Address2: | 8TH FLR. | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100013212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125642350 | ||||||||
| FaxNumber: | 2125642578 | ||||||||
| Practice Location | |||||||||
| Address1: | 116 W 32ND ST | ||||||||
| Address2: | 8TH FLR. | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100013212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125642350 | ||||||||
| FaxNumber: | 2125642578 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2009 | ||||||||
| LastUpdateDate: | 01/07/2009 | ||||||||
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| AuthorizedOfficialLastName: | CALDERON | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2125642350 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THERACARE OF NEW YORK, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 252Y00000X | N | Agencies | Early Intervention Provider Agency | 251C00000X | Y | Agencies | Day Training, Developmentally Disabled Services |
No ID Information.