Organization
THERACARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ULETTE FIELDS (STAFFING COORDINATOR)
(718) 830-9274
Entity
Organization
Contact information
Practice address
21050 41ST AVE, 4C, BAYSIDE, NY 11361-1965
(631) 839-4703
Mailing address
21050 41ST AVE, 4C, BAYSIDE, NY 11361-1965
(631) 839-4703
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
391713101
NY
Other
Enumeration date
06/07/2012
Last updated
06/07/2012
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