Provider Demographics
NPI:1629406111
Name:PROCARE REHAB AND WOUND SOLUTIONS PROF CORP
Entity Type:Organization
Organization Name:PROCARE REHAB AND WOUND SOLUTIONS PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBASEKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-254-6420
Mailing Address - Street 1:PO BOX 2337
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-0977
Mailing Address - Country:US
Mailing Address - Phone:812-254-6420
Mailing Address - Fax:
Practice Address - Street 1:1110 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-3031
Practice Address - Country:US
Practice Address - Phone:812-254-6420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000903261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care