Provider Demographics
NPI:1255531570
Name:PROHEALTH HOME CARE, INC.
Entity type:Organization
Organization Name:PROHEALTH HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:SHAHRAM
Authorized Official - Last Name:MARLEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-451-9055
Mailing Address - Street 1:2700 ZANKER RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-2139
Mailing Address - Country:US
Mailing Address - Phone:408-451-9055
Mailing Address - Fax:408-451-9217
Practice Address - Street 1:2700 ZANKER RD
Practice Address - Street 2:SUITE 180
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95134-2139
Practice Address - Country:US
Practice Address - Phone:408-451-9055
Practice Address - Fax:408-451-9217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251G00000X
CA223800251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551561Medicare Oscar/Certification