Provider Demographics
NPI:1508678210
Name:ROBERT THADEUS MANAGEMENT CORP
Entity type:Organization
Organization Name:ROBERT THADEUS MANAGEMENT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:THADEUS
Authorized Official - Last Name:WIEBORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-743-0056
Mailing Address - Street 1:5918 E KILLEN LOOP
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-0111
Mailing Address - Country:US
Mailing Address - Phone:714-743-0056
Mailing Address - Fax:
Practice Address - Street 1:5918 E KILLEN LOOP
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-0111
Practice Address - Country:US
Practice Address - Phone:714-743-0056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care