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General NPI Number Information
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NPI Number | 1811044118
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Entity Type | Organization
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Legal Business Name | PRO CARE HELATH PLAN INC.
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3956 MOUNT ELLIOTT ST
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City | DETROIT
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State | MI
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Zip | 48207-1841
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Country | US
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Telephone | 313-925-4607
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Fax | 313-925-0472
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Provider Business Mailing Address
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Address Line | 3956 MOUNT ELLIOTT ST
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City | DETROIT
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State | MI
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Zip | 48207-1841
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Country | US
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Telephone | 313-925-4607
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Fax | 313-925-0472
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Authorized Official
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Title or Position | COO
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Name | MS. ROBIN COLE
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Credential | MSN, MBA
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Telephone | 313-925-0228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State | MI
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