Provider Demographics
NPI:1396025557
Name:PRO CARE
Entity Type:Organization
Organization Name:PRO CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NONE
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARWIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-681-0073
Mailing Address - Street 1:14650 BAYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-2459
Mailing Address - Country:US
Mailing Address - Phone:646-662-1605
Mailing Address - Fax:
Practice Address - Street 1:9845 ROOSEVELT RD.
Practice Address - Street 2:PRO CARE
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154
Practice Address - Country:US
Practice Address - Phone:708-681-2325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health