Provider Demographics
NPI:1295873990
Name:PROCARE HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:PROCARE HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:VERNALENE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:818-773-9080
Mailing Address - Street 1:15034 PROVIDENCE LN
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-3477
Mailing Address - Country:US
Mailing Address - Phone:818-773-9080
Mailing Address - Fax:818-895-8625
Practice Address - Street 1:15034 PROVIDENCE LN
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-3477
Practice Address - Country:US
Practice Address - Phone:818-773-9080
Practice Address - Fax:818-895-8625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1422231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGAU000840Medicaid
CAGAU000840Medicaid