1104888635 NPI number — THERACARE, INC.

Table of content: (NPI 1104888635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104888635 NPI number — THERACARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERACARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104888635
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25354 BLUE SKIES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUSTER
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57730-7113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-673-3488
Provider Business Mailing Address Fax Number:
605-673-3496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
602 MOUNT RUSHMORE RD
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
CUSTER
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57730-2031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-673-3488
Provider Business Practice Location Address Fax Number:
605-673-3496
Provider Enumeration Date:
04/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NITSCHELM
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
KAYE
Authorized Official Title or Position:
DIRECTOR/SPEECH-LANGUAGE PATHOLOGIS
Authorized Official Telephone Number:
605-673-3488

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  N/A , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com