Provider Demographics
NPI:1346537966
Name:PRO-HEALTH PATIENT CARE NETWORK, LLC
Entity Type:Organization
Organization Name:PRO-HEALTH PATIENT CARE NETWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:K
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:888-666-9338
Mailing Address - Street 1:13768 ROSWELL AVE
Mailing Address - Street 2:#209
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-1401
Mailing Address - Country:US
Mailing Address - Phone:888-666-9338
Mailing Address - Fax:
Practice Address - Street 1:1142 S DIAMOND BAR BLVD
Practice Address - Street 2:#796
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-2203
Practice Address - Country:US
Practice Address - Phone:888-666-9338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-03
Last Update Date:2011-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health