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General NPI Number Information
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NPI Number | 1023288859
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Entity Type | Organization
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Legal Business Name | PROCARE PROFESSIONAL SERVICES INC.
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Dates
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Enumeration Date | 03/07/2008
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Last Update Date | 03/07/2008
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Provider Practice Location Address
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Address Line | 1903 REDONDO AVE
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City | SIGNAL HILL
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State | CA
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Zip | 90755-1226
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Country | US
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Telephone | 562-494-6500
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Fax | 562-494-8834
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Provider Business Mailing Address
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Address Line | 1903 REDONDO AVE
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City | SIGNAL HILL
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State | CA
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Zip | 90755-1226
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Country | US
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Telephone | 562-494-6500
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Fax | 562-494-8836
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. STEPHEN B LISS
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Credential |
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Telephone | 562-494-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 980000827
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number | 980000827
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 980000827
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 980000827
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License Number State | CA
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