Provider Demographics
NPI:1467497172
Name:PROCARE MOBILE RESPONSE, LLC
Entity Type:Organization
Organization Name:PROCARE MOBILE RESPONSE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ZINOVY
Authorized Official - Middle Name:
Authorized Official - Last Name:GANOPOLSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-676-0311
Mailing Address - Street 1:2702 MEDIA CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-1733
Mailing Address - Country:US
Mailing Address - Phone:800-676-0311
Mailing Address - Fax:800-676-4133
Practice Address - Street 1:2702 MEDIA CENTER DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-1733
Practice Address - Country:US
Practice Address - Phone:800-676-0311
Practice Address - Fax:800-676-4133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18853416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTE01167FMedicaid
CAMTE01167FMedicaid
CAZ532Medicare ID - Type Unspecified