Healthcare Provider Details

I. General information

NPI: 1689943243
Provider Name (Legal Business Name): PROHEALTH HOME CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2011
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 OAK GROVE RD STE 124A
WALNUT CREEK CA
94598-2534
US

IV. Provider business mailing address

2125 OAK GROVE RD STE 124A
WALNUT CREEK CA
94598-2534
US

V. Phone/Fax

Practice location:
  • Phone: 877-258-0336
  • Fax: 408-451-9217
Mailing address:
  • Phone: 877-258-0336
  • Fax: 408-451-9217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MOHAMED SHAHRAM MARLEEN
Title or Position: PRESIDENT
Credential:
Phone: 408-451-9055