Provider Demographics
NPI:1255867560
Name:PROCARE HOME HEALTH LLC
Entity Type:Organization
Organization Name:PROCARE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREESHMA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOTAKURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-880-4884
Mailing Address - Street 1:13800 COPPERMINE RD STE 157
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-6163
Mailing Address - Country:US
Mailing Address - Phone:248-303-3693
Mailing Address - Fax:
Practice Address - Street 1:13800 COPPERMINE RD STE 157
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-6163
Practice Address - Country:US
Practice Address - Phone:248-303-3693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-05
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health