MEDICARE: PROCARE HOME HEALTH SERVICES INC

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1427044544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROCARE HOME HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	9683 TIERRA GRANDE ST
Second Line	:	SUITE 201
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-6503
Country	:	US
Telephone Number	:	858-695-2101
Fax Number	:	858-695-2208

Provider Business Practice Location Address
First Line	:	9683 TIERRA GRANDE ST
Second Line	:	SUITE 201
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-6503
Country	:	US
Telephone Number	:	858-695-2101
Fax Number	:	858-695-2208

Authorized Official
Title or Position	:	ADMINISTRATOR / PRESIDENT / CEO
Name	:	MR. GABRIEL INOCENCIO PERPETUA SR.
Credential	:
Telephone Number	:	858-695-2101

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	08/22/2020

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