Provider Demographics
NPI:1821390527
Name:THERESA ROBERT, LLC
Entity Type:Organization
Organization Name:THERESA ROBERT, LLC
Other - Org Name:THERESA ROBERT LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED NURSE CASE MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:269-598-0665
Mailing Address - Street 1:551 CARRINGTON CT
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-2469
Mailing Address - Country:US
Mailing Address - Phone:269-598-0665
Mailing Address - Fax:
Practice Address - Street 1:551 CARRINGTON CT
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2469
Practice Address - Country:US
Practice Address - Phone:269-598-0665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704208409251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management