Provider Demographics
NPI:1497739544
Name:PROCARE HOME HEALTH INC
Entity Type:Organization
Organization Name:PROCARE HOME HEALTH INC
Other - Org Name:VNA HEALTHTRENDS, LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HENEGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:847-803-0774
Mailing Address - Street 1:200 HOWARD AVE
Mailing Address - Street 2:STE 248
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-5906
Mailing Address - Country:US
Mailing Address - Phone:847-803-0774
Mailing Address - Fax:847-803-0821
Practice Address - Street 1:200 HOWARD AVE
Practice Address - Street 2:STE 248
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-5906
Practice Address - Country:US
Practice Address - Phone:847-803-0774
Practice Address - Fax:847-803-0821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1009042251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5142OtherBLUE CROSS PROVIDER NUMBE
IL147292Medicare Oscar/Certification