MEDICARE: PRO-CARE HOME HEALTH LIMITED

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	273Y00000X	Rehabilitation Hospital Unit
2	251B00000X	Case Management Agency	150138	KY
3	251E00000X	Home Health Agency	150138	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	45003522	OTHER	KY	KY EPSDT
3	42000158	OTHER	KY	WAIVER

General Provider Information

NPI Number	:	1356344733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRO-CARE HOME HEALTH LIMITED

Provider Business Mailing Address
First Line	:	PO BOX 109
Second Line	:
City	:	HARTFORD
State	:	KY
Zip	:	42347-0109
Country	:	US
Telephone Number	:	270-298-3112
Fax Number	:	270-298-4766

Provider Business Practice Location Address
First Line	:	122 W UNION ST
Second Line	:
City	:	HARTFORD
State	:	KY
Zip	:	42347-1416
Country	:	US
Telephone Number	:	270-298-3112
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF INFORMATION SYSTEMS
Name	:	KEVIN BAILEY
Credential	:
Telephone Number	:	270-298-3112

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	03/01/2010

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