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Organization

THERAWIDE, LLC

Active
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Organization

THERAWIDE, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
BRANDON HIGHTOWER (CEO/DIRECTOR OF OPERATIONS)
(310) 307-9114
Entity
Organization

Contact information

Practice address
591 COLLINS DR APT 6, MERCED, CA 95348-3178
(310) 307-9114
Mailing address
591 COLLINS DR APT 6, MERCED, CA 95348-3178

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
235Z00000X
Speech-Language Pathologist
251E00000X
Home Health Agency

Other

Enumeration date
02/13/2020
Last updated
02/13/2020
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