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General NPI Number Information
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NPI Number | 1558616946
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Entity Type | Organization
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Legal Business Name | PROCARE HEALTHCARE INC.
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Dates
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Enumeration Date | 07/21/2012
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Last Update Date | 01/28/2018
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Provider Practice Location Address
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Address Line | 77 WELLSLEY WAY
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City | DALLAS
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State | GA
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Zip | 30132-9775
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Country | US
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Telephone | 678-698-0731
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Fax |
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Provider Business Mailing Address
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Address Line | 77 WELLSLEY WAY
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City | DALLAS
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State | GA
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Zip | 30132-9775
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Country | US
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Telephone | 678-698-0731
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JOSEPH C. DURU
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Credential | BS. RT(R),CNMT
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Telephone | 678-698-0731
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 110-R-0812
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 110-R-0812
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 110-R-0812
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License Number State | GA
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