Provider Demographics
NPI:1669613709
Name:PROSOURCE
Entity type:Organization
Organization Name:PROSOURCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMININSTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-736-9552
Mailing Address - Street 1:3011 CARTWRIGHT RD
Mailing Address - Street 2:STE. 200
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-2626
Mailing Address - Country:US
Mailing Address - Phone:281-736-9552
Mailing Address - Fax:281-416-2190
Practice Address - Street 1:3011 CARTWRIGHT RD
Practice Address - Street 2:STE. 200
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-2626
Practice Address - Country:US
Practice Address - Phone:281-736-9552
Practice Address - Fax:281-416-2190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health