Provider Demographics
NPI:1659921427
Name:TERPRO LLC
Entity Type:Organization
Organization Name:TERPRO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-900-6364
Mailing Address - Street 1:8175 W LUDLOW DR UNIT 222
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4796
Mailing Address - Country:US
Mailing Address - Phone:602-900-6364
Mailing Address - Fax:
Practice Address - Street 1:8175 W LUDLOW DR UNIT 222
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4796
Practice Address - Country:US
Practice Address - Phone:602-900-6364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health