Provider Demographics
NPI:1093063877
Name:PRO CARE HOMECARE GIVERS SERVICE
Entity Type:Organization
Organization Name:PRO CARE HOMECARE GIVERS SERVICE
Other - Org Name:PRO CARE HOMECARE GIVERS SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CNA
Authorized Official - Prefix:
Authorized Official - First Name:REINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-818-3839
Mailing Address - Street 1:14818 MADRIS
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650
Mailing Address - Country:US
Mailing Address - Phone:562-818-3839
Mailing Address - Fax:
Practice Address - Street 1:14818 MADRIS AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-6057
Practice Address - Country:US
Practice Address - Phone:562-818-3839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health