Provider Demographics
NPI:1558616946
Name:PROCARE HEALTHCARE INC.
Entity Type:Organization
Organization Name:PROCARE HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:DURU
Authorized Official - Suffix:
Authorized Official - Credentials:BS RT(R),CNMT
Authorized Official - Phone:678-698-0731
Mailing Address - Street 1:77 WELLSLEY WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-9775
Mailing Address - Country:US
Mailing Address - Phone:678-698-0731
Mailing Address - Fax:
Practice Address - Street 1:77 WELLSLEY WAY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-9775
Practice Address - Country:US
Practice Address - Phone:678-698-0731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-21
Last Update Date:2018-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA110-R-0812251E00000X, 251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care