Provider Demographics
NPI:1679905178
Name:THERACARE COMMUNITY CENTER, INC.
Entity type:Organization
Organization Name:THERACARE COMMUNITY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:954-256-4601
Mailing Address - Street 1:5010 SW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3271
Mailing Address - Country:US
Mailing Address - Phone:954-256-4601
Mailing Address - Fax:
Practice Address - Street 1:7481 W OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 302 C
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-4985
Practice Address - Country:US
Practice Address - Phone:954-256-4601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-07
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2758251B00000X, 251S00000X, 261QM0801X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health