Healthcare Provider Details

I. General information

NPI: 1356344733
Provider Name (Legal Business Name): PRO-CARE HOME HEALTH LIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 W UNION ST
HARTFORD KY
42347-1416
US

IV. Provider business mailing address

PO BOX 109
HARTFORD KY
42347-0109
US

V. Phone/Fax

Practice location:
  • Phone: 270-298-3112
  • Fax:
Mailing address:
  • Phone: 270-298-3112
  • Fax: 270-298-4766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number150138
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number150138
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: KEVIN BAILEY
Title or Position: DIRECTOR OF INFORMATION SYSTEMS
Credential:
Phone: 270-298-3112