MEDICARE: PROXCELL 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1861980377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROXCELL INC.

Provider Business Mailing Address
First Line	:	4262 LAKEFALL CT
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92505-3459
Country	:	US
Telephone Number	:	951-318-9143
Fax Number	:

Provider Business Practice Location Address
First Line	:	4262 LAKEFALL CT
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92505-3459
Country	:	US
Telephone Number	:	951-318-9143
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MATTHEW USIGBE
Credential	:
Telephone Number	:	951-318-9143

Provider Enumeration Date	:	04/30/2018
Last Update Date	:	04/30/2018

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