Provider Demographics
NPI:1780185884
Name:PROCEDA HEALTH LLC
Entity Type:Organization
Organization Name:PROCEDA HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KOKOE
Authorized Official - Middle Name:
Authorized Official - Last Name:EZUI
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, LPN
Authorized Official - Phone:571-598-4008
Mailing Address - Street 1:PO BOX 2182
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20146-9082
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44043 FERNCLIFF TER
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3329
Practice Address - Country:US
Practice Address - Phone:240-343-3105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)