Provider Demographics
NPI:1689146532
Name:PROCARE HOSPICE, INC.
Entity Type:Organization
Organization Name:PROCARE HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:818-660-2931
Mailing Address - Street 1:14852 VENTURA BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-5946
Mailing Address - Country:US
Mailing Address - Phone:818-660-2931
Mailing Address - Fax:818-660-2269
Practice Address - Street 1:14852 VENTURA BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-5946
Practice Address - Country:US
Practice Address - Phone:818-660-2931
Practice Address - Fax:818-660-2269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based