1194057232 NPI number — PROCARE HOME HEALTH CARE AGENCY, LLC

Table of content: (NPI 1194057232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194057232 NPI number — PROCARE HOME HEALTH CARE AGENCY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROCARE HOME HEALTH CARE AGENCY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194057232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 HIDDEN ACRES DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VOORHEES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08043-1551
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-466-9653
Provider Business Mailing Address Fax Number:
888-573-7634

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41 UNIVERSITY DR
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
NEWTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18940-1873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-809-2029
Provider Business Practice Location Address Fax Number:
888-573-7634
Provider Enumeration Date:
01/30/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GELLER
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
BRUCE
Authorized Official Title or Position:
ADMINISTRATOR/MEDICAL DIRECTOR
Authorized Official Telephone Number:
856-466-9653

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  03950501 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)