Healthcare Provider Details

I. General information

NPI: 1215375175
Provider Name (Legal Business Name): PROHEALTH HOME CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 EXPOSITION BLVD SUITE 250A & 250B
SACRAMENTO CA
95815-5115
US

IV. Provider business mailing address

1375 EXPOSITION BLVD SUITE 250A & 250B
SACRAMENTO CA
95815-5115
US

V. Phone/Fax

Practice location:
  • Phone: 877-267-1960
  • Fax:
Mailing address:
  • Phone: 915-221-5701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MOHAMED MARLEEN
Title or Position: OWNER
Credential:
Phone: 916-221-5701