MEDICARE: PROHEALTH HOME CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency		CA
2	251E00000X	Home Health Agency	223800	CA

General Provider Information

NPI Number	:	1255531570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROHEALTH HOME CARE, INC.

Provider Business Mailing Address
First Line	:	2700 ZANKER RD
Second Line	:	SUITE 180
City	:	SAN JOSE
State	:	CA
Zip	:	95134-2139
Country	:	US
Telephone Number	:	408-451-9055
Fax Number	:	408-451-9217

Provider Business Practice Location Address
First Line	:	2700 ZANKER RD
Second Line	:	SUITE 180
City	:	SAN JOSE
State	:	CA
Zip	:	95134-2139
Country	:	US
Telephone Number	:	408-451-9055
Fax Number	:	408-451-9217

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MOHAMED SHAHRAM MARLEEN
Credential	:
Telephone Number	:	408-451-9055

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	03/20/2024

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