Provider Demographics
NPI:1023288859
Name:PROCARE PROFESSIONAL SERVICES INC.
Entity type:Organization
Organization Name:PROCARE PROFESSIONAL SERVICES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:LISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-494-6500
Mailing Address - Street 1:1903 REDONDO AVE
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-1226
Mailing Address - Country:US
Mailing Address - Phone:562-494-6500
Mailing Address - Fax:562-494-8836
Practice Address - Street 1:1903 REDONDO AVE
Practice Address - Street 2:
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-1226
Practice Address - Country:US
Practice Address - Phone:562-494-6500
Practice Address - Fax:562-494-8834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA980000827251B00000X, 251F00000X, 251J00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care