Healthcare Provider Details

I. General information

NPI: 1134841356
Provider Name (Legal Business Name): PROCARE TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 LATITUDES WAY
RICHMOND CA
94804
US

IV. Provider business mailing address

1465 LATITUDES WAY
RICHMOND CA
94804
US

V. Phone/Fax

Practice location:
  • Phone: 734-589-5092
  • Fax:
Mailing address:
  • Phone: 734-589-5092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. OGBEMUDIA IYOHA
Title or Position: CEO
Credential: RN
Phone: 269-352-1845