Provider Demographics
NPI:1639176514
Name:THERAPEUTIC HOME CARE
Entity Type:Organization
Organization Name:THERAPEUTIC HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:MARION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-240-9233
Mailing Address - Street 1:580 E 3RD ST # F
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-0184
Mailing Address - Country:US
Mailing Address - Phone:805-240-9233
Mailing Address - Fax:805-240-7875
Practice Address - Street 1:580 E 3RD ST # F
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-0184
Practice Address - Country:US
Practice Address - Phone:805-240-9233
Practice Address - Fax:805-240-7875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57244332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4959250001Medicare ID - Type Unspecified
CA4959250001Medicare PIN
CA4959250001Medicare NSC