Provider Demographics
NPI:1134841356
Name:PROCARE TRANSPORT
Entity type:Organization
Organization Name:PROCARE TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:OGBEMUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:IYOHA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:269-352-1845
Mailing Address - Street 1:1465 LATITUDES WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804
Mailing Address - Country:US
Mailing Address - Phone:734-589-5092
Mailing Address - Fax:
Practice Address - Street 1:1465 LATITUDES WAY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804
Practice Address - Country:US
Practice Address - Phone:734-589-5092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROCARE RESIDENTIAL SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle