Provider Demographics
NPI:1548604614
Name:LARJAR
Entity Type:Organization
Organization Name:LARJAR
Other - Org Name:PROCARE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CORTLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:REILLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-769-3890
Mailing Address - Street 1:4710 EISENHOWER BLVD
Mailing Address - Street 2:STE C-2
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33511
Mailing Address - Country:US
Mailing Address - Phone:813-769-3886
Mailing Address - Fax:813-769-3883
Practice Address - Street 1:4710 EISENHOWER BLVD STE C2
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-6334
Practice Address - Country:US
Practice Address - Phone:813-769-3880
Practice Address - Fax:813-769-3883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-19
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171R00000X, 172A00000X
FLP07000002637347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes347E00000XTransportation ServicesTransportation BrokerGroup - Multi-Specialty
No171R00000XOther Service ProvidersInterpreterGroup - Multi-Specialty
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty