Healthcare Provider Details

I. General information

NPI: 1952544512
Provider Name (Legal Business Name): PROCARE PCA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 E DUNBAR DR STE C2
WASILLA AK
99654-7758
US

IV. Provider business mailing address

PO BOX 143221
ANCHORAGE AK
99514-3221
US

V. Phone/Fax

Practice location:
  • Phone: 907-357-7825
  • Fax: 907-357-7883
Mailing address:
  • Phone: 907-357-7825
  • Fax: 907-357-7883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number925870
License Number StateAK

VIII. Authorized Official

Name: CAROL REBECCA SYCKS
Title or Position: PRESIDENT
Credential: RN
Phone: 907-297-2778