Healthcare Provider Details

I. General information

NPI: 1447556410
Provider Name (Legal Business Name): PROCARE HOME HEALTH PROVIDERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 HUNT CLUB PLZ
RIDGELEY WV
26753-5213
US

IV. Provider business mailing address

5 HUNT CLUB PLZ
RIDGELEY WV
26753-5213
US

V. Phone/Fax

Practice location:
  • Phone: 304-738-4110
  • Fax: 304-738-4118
Mailing address:
  • Phone: 304-738-4110
  • Fax: 304-738-4118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELEANOR ANN WILSON
Title or Position: PARTNER
Credential:
Phone: 304-738-4110