Provider Demographics
NPI:1043391725
Name:PROCARE HOME MEDICAL, INC.
Entity Type:Organization
Organization Name:PROCARE HOME MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:SYCKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-274-0770
Mailing Address - Street 1:725 NORTHWAY DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2030
Mailing Address - Country:US
Mailing Address - Phone:907-274-0770
Mailing Address - Fax:907-274-0773
Practice Address - Street 1:5050 E DUNBAR DR
Practice Address - Street 2:STE C2
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7758
Practice Address - Country:US
Practice Address - Phone:907-357-7882
Practice Address - Fax:907-357-7883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK405559332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMS9610Medicaid