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General NPI Number Information
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NPI Number | 1053526624
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Entity Type | Organization
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Legal Business Name | PROCARE HEALING CENTERS, LLP
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2519 S. LAKELINE BOULEVARD UNIT 101
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City | CEDAR PARK
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State | TX
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Zip | 78613
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Country | US
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Telephone | 512-249-9498
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Fax | 512-608-9268
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Provider Business Mailing Address
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Address Line | 6307 WATERFORD BLVD SUITE 210
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City | OKLAHOMA CITY
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State | OK
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Zip | 73118-1125
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Country | US
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Telephone | 405-608-0350
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Fax | 405-608-0349
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Authorized Official
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Title or Position | CEO
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Name | MR. GAIL SUE DEVILLIERS
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Credential | R.N.
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Telephone | 405-608-0350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State | TX
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