Provider Demographics
NPI:1790969699
Name:CALIFORNIA THERACARE SERVICES
Entity Type:Organization
Organization Name:CALIFORNIA THERACARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:KEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:209-576-7280
Mailing Address - Street 1:5225 PENTECOST DR
Mailing Address - Street 2:SUITE 26
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-9284
Mailing Address - Country:US
Mailing Address - Phone:209-576-7280
Mailing Address - Fax:209-576-7275
Practice Address - Street 1:5225 PENTECOST DR
Practice Address - Street 2:SUITE 26
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9284
Practice Address - Country:US
Practice Address - Phone:209-576-7280
Practice Address - Fax:209-576-7275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13753235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty