Provider Demographics
NPI:1902415748
Name:THERANORTH SERVICES, LLC
Entity Type:Organization
Organization Name:THERANORTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONCHES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:973-703-9591
Mailing Address - Street 1:1075 EASTON AVE.
Mailing Address - Street 2:TOWER 2 #4
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873
Mailing Address - Country:US
Mailing Address - Phone:973-703-9591
Mailing Address - Fax:732-246-7006
Practice Address - Street 1:1075 EASTON AVE.
Practice Address - Street 2:TOWER 2 #4
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873
Practice Address - Country:US
Practice Address - Phone:973-703-9591
Practice Address - Fax:732-246-7006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services