MEDICARE: PROCARE HOME HEALTH LLC

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1477919652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROCARE HOME HEALTH LLC

Provider Business Mailing Address
First Line	:	1033 CORPORATE SQUARE DR
Second Line	:	STE 127
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-2928
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1033 CORPORATE SQUARE DR
Second Line	:	STE 127
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-2928
Country	:	US
Telephone Number	:	314-757-8517
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIGRE SMITH
Credential	:	RN, BSN
Telephone Number	:	314-757-8517

Provider Enumeration Date	:	01/04/2016
Last Update Date	:	01/04/2016

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Directions to “PROCARE HOME HEALTH LLC ” Practice Location

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