Provider Demographics
NPI:1861828725
Name:PROCARE AMBULETTE SERVICE, LLC
Entity Type:Organization
Organization Name:PROCARE AMBULETTE SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:G
Authorized Official - Last Name:LESACA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-446-6440
Mailing Address - Street 1:50 JENNINGS LN
Mailing Address - Street 2:
Mailing Address - City:NORTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-3706
Mailing Address - Country:US
Mailing Address - Phone:201-446-6440
Mailing Address - Fax:
Practice Address - Street 1:50 JENNINGS LN
Practice Address - Street 2:
Practice Address - City:NORTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-3706
Practice Address - Country:US
Practice Address - Phone:201-446-6440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)