=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194057232
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROCARE HOME HEALTH CARE AGENCY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2010
-----------------------------------------------------
Last Update Date | 01/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 41 UNIVERSITY DR SUITE 400
-----------------------------------------------------
City | NEWTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18940-1873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-809-2029
-----------------------------------------------------
Fax | 888-573-7634
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21 HIDDEN ACRES DR
-----------------------------------------------------
City | VOORHEES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08043-1551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-466-9653
-----------------------------------------------------
Fax | 888-573-7634
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR/MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. JEFFREY BRUCE GELLER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 856-466-9653
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 03950501
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------