Provider Demographics
NPI:1689011603
Name:THERACARE, INC.
Entity Type:Organization
Organization Name:THERACARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:ISSA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:954-647-8578
Mailing Address - Street 1:2808 NE 22ND ST
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33305-2804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:954-564-1371
Practice Address - Street 1:2808 NE 22ND ST
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33305-2804
Practice Address - Country:US
Practice Address - Phone:954-980-5002
Practice Address - Fax:954-564-1371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW85711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAD487ZMedicare PIN