Provider Demographics
NPI:1831509264
Name:THERACARE, INC.
Entity type:Organization
Organization Name:THERACARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIZEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:EDS, OTR/L
Authorized Official - Phone:606-599-1709
Mailing Address - Street 1:485 MEMORIAL DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MANCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40962-9156
Mailing Address - Country:US
Mailing Address - Phone:606-599-1709
Mailing Address - Fax:606-599-8549
Practice Address - Street 1:485 MEMORIAL DR
Practice Address - Street 2:SUITE 2
Practice Address - City:MANCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40962-9156
Practice Address - Country:US
Practice Address - Phone:606-599-1709
Practice Address - Fax:606-599-8549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYRO334174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty