Provider Demographics
NPI:1558834036
Name:THERACARE MANAGED SERVICES, LLC
Entity Type:Organization
Organization Name:THERACARE MANAGED SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-564-2350
Mailing Address - Street 1:116 WEST 32ND ST.
Mailing Address - Street 2:8TH FLR.
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001
Mailing Address - Country:US
Mailing Address - Phone:212-564-2350
Mailing Address - Fax:212-564-2578
Practice Address - Street 1:11-20 46TH ROAD
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101
Practice Address - Country:US
Practice Address - Phone:855-681-8555
Practice Address - Fax:914-560-2102
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THERACARE OF NEW YORK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty