Healthcare Provider Details

I. General information

NPI: 1306072574
Provider Name (Legal Business Name): PROCARE HOME HEALTH & SENIOR SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MARKET STREET SUITE 206
MANCHESTER NH
03101
US

IV. Provider business mailing address

20 MARKET STREET SUITE 206
MANCHESTER NH
03101
US

V. Phone/Fax

Practice location:
  • Phone: 603-621-1411
  • Fax: 603-621-2927
Mailing address:
  • Phone: 603-621-1411
  • Fax: 603-621-2927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number03334
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number03863
License Number StateNH

VIII. Authorized Official

Name: MRS. JANE ANN ROTHWELL
Title or Position: ADMINISTRATOR
Credential: REGISTERED NURSE
Phone: 603-621-1411