Healthcare Provider Details

I. General information

NPI: 1568840908
Provider Name (Legal Business Name): PROCARE HEALTH ASSESSORS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 JASMINE LN
COLUMBIA SC
29203-5164
US

IV. Provider business mailing address

517 JASMINE LN
COLUMBIA SC
29203-5164
US

V. Phone/Fax

Practice location:
  • Phone: 803-666-8475
  • Fax:
Mailing address:
  • Phone: 803-666-8475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateSC

VIII. Authorized Official

Name: ANDRE SANDERS
Title or Position: ONWER
Credential:
Phone: 803-730-2947