Provider Demographics
NPI:1659561207
Name:PROCARE HOME HEALTH AGENCY INC
Entity Type:Organization
Organization Name:PROCARE HOME HEALTH AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVADOR
Authorized Official - Middle Name:LOLARGA
Authorized Official - Last Name:ABIERA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, PT
Authorized Official - Phone:323-888-6788
Mailing Address - Street 1:1493 N MONTEBELLO BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-2588
Mailing Address - Country:US
Mailing Address - Phone:323-888-6788
Mailing Address - Fax:323-888-6780
Practice Address - Street 1:1493 N MONTEBELLO BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-2586
Practice Address - Country:US
Practice Address - Phone:323-888-6788
Practice Address - Fax:323-888-6780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000919251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA434714OtherJCAHO ACCREDITATION
CA550000919OtherCDPH FACILITY LICENSE
CA059286Medicare Oscar/Certification