Provider Demographics
NPI:1447556410
Name:PROCARE HOME HEALTH PROVIDERS, LLC
Entity Type:Organization
Organization Name:PROCARE HOME HEALTH PROVIDERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-738-4110
Mailing Address - Street 1:5 HUNT CLUB PLZ
Mailing Address - Street 2:
Mailing Address - City:RIDGELEY
Mailing Address - State:WV
Mailing Address - Zip Code:26753-5213
Mailing Address - Country:US
Mailing Address - Phone:304-738-4110
Mailing Address - Fax:304-738-4118
Practice Address - Street 1:5 HUNT CLUB PLZ
Practice Address - Street 2:
Practice Address - City:RIDGELEY
Practice Address - State:WV
Practice Address - Zip Code:26753-5213
Practice Address - Country:US
Practice Address - Phone:304-738-4110
Practice Address - Fax:304-738-4118
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROCARE HOME HEALTH PROVIDERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management