Healthcare Provider Details

I. General information

NPI: 1609753300
Provider Name (Legal Business Name): PROCARE TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1396 CLAY ST NE
SALEM OR
97301-1947
US

IV. Provider business mailing address

1396 CLAY ST NE
SALEM OR
97301-1947
US

V. Phone/Fax

Practice location:
  • Phone: 651-529-7356
  • Fax: 503-506-0620
Mailing address:
  • Phone: 651-529-7356
  • Fax: 503-506-0620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: ALEM DESTA
Title or Position: DIRECTOR
Credential:
Phone: 651-529-7356