MEDICARE: PROCARE HOME MEDICAL SUPPLY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	20043579	AZ

General Provider Information

NPI Number	:	1083804504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROCARE HOME MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	PO BOX 751
Second Line	:
City	:	EL MIRAGE
State	:	AZ
Zip	:	85335-0751
Country	:	US
Telephone Number	:	602-703-7778
Fax Number	:

Provider Business Practice Location Address
First Line	:	12420 W THUNDERBIRD RD # 11C
Second Line	:
City	:	EL MIRAGE
State	:	AZ
Zip	:	85335-3113
Country	:	US
Telephone Number	:	602-703-7778
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. RAFAEL C CASTRO
Credential	:
Telephone Number	:	602-703-7778

Provider Enumeration Date	:	07/31/2007
Last Update Date	:	07/31/2007

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