Healthcare Provider Details

I. General information

NPI: 1730836636
Provider Name (Legal Business Name): PROCARE-B, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 KAYEN CHANDO
DEDEDO GU
96929-5900
US

IV. Provider business mailing address

PO BOX 11864
TAMUNING GU
96931-1864
US

V. Phone/Fax

Practice location:
  • Phone: 671-632-7000
  • Fax: 671-632-7001
Mailing address:
  • Phone: 671-632-7000
  • Fax: 671-632-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. TANIA RAMOS
Title or Position: BUSINESS DEVELOPMENT OFFICER
Credential:
Phone: 671-632-7000