Healthcare Provider Details

I. General information

NPI: 1952625733
Provider Name (Legal Business Name): PROSTAT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19601 BERNVILLE RD
READING PA
19601-1113
US

IV. Provider business mailing address

1901 BERNVILLE RD.
READING PA
19601-1113
US

V. Phone/Fax

Practice location:
  • Phone: 610-736-9000
  • Fax: 610-736-9006
Mailing address:
  • Phone: 610-736-9000
  • Fax: 610-736-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number13773601
License Number StatePA

VIII. Authorized Official

Name: MR. DAVID EUGENE SHELLY
Title or Position: COO
Credential:
Phone: 610-736-9000