Provider Demographics
NPI:1790051563
Name:THERACARE
Entity Type:Organization
Organization Name:THERACARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPY ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:317-757-9384
Mailing Address - Street 1:5356 HOLLY SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-4284
Mailing Address - Country:US
Mailing Address - Phone:317-757-9384
Mailing Address - Fax:
Practice Address - Street 1:5356 HOLLY SPRINGS CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254
Practice Address - Country:US
Practice Address - Phone:317-757-9384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001792A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility