MEDICARE: PROCARE LIFE SERVICES, 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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1649806258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROCARE LIFE SERVICES, LLC

Provider Business Mailing Address
First Line	:	350 E 47TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-1845
Country	:	US
Telephone Number	:	786-537-7658
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 E 47TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-1845
Country	:	US
Telephone Number	:	786-537-7658
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ARIADNA AZTARAIN CABO
Credential	:
Telephone Number	:	786-537-7658

Provider Enumeration Date	:	03/14/2020
Last Update Date	:	03/14/2020

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Directions to “PROCARE LIFE SERVICES, LLC ” Practice Location

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