Provider Demographics
NPI:1629895545
Name:PROVCARE HOME CARE AGENCY LLC
Entity type:Organization
Organization Name:PROVCARE HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZARGARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-755-3488
Mailing Address - Street 1:140 SAN GABRIEL DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-2842
Mailing Address - Country:US
Mailing Address - Phone:718-755-3488
Mailing Address - Fax:
Practice Address - Street 1:203 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-2154
Practice Address - Country:US
Practice Address - Phone:816-226-8585
Practice Address - Fax:816-787-1341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care