Provider Demographics
NPI: | 1013034321 |
---|---|
Name: | THERAPEUTIC SERVICES GROUP |
Entity Type: | Organization |
Organization Name: | THERAPEUTIC SERVICES GROUP |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | AGENCY OWNER |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | LINDA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | STUCCHI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 704-849-8621 |
Mailing Address - Street 1: | 6621 AUGUSTINE WAY |
Mailing Address - Street 2: | |
Mailing Address - City: | CHARLOTTE |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28270-0891 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 704-849-8621 |
Mailing Address - Fax: | 704-849-7349 |
Practice Address - Street 1: | 6621 AUGUSTINE WAY |
Practice Address - Street 2: | |
Practice Address - City: | CHARLOTTE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28270-0891 |
Practice Address - Country: | US |
Practice Address - Phone: | 704-849-8621 |
Practice Address - Fax: | 704-849-7349 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-03-23 |
Last Update Date: | 2007-07-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251C00000X | Agencies | Day Training, Developmentally Disabled Services |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 3409689 | Medicaid |