Provider Demographics
NPI:1063108264
Name:PROACTIVE HOME CARE LLC
Entity type:Organization
Organization Name:PROACTIVE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:RABIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-785-0622
Mailing Address - Street 1:1950 S ROCHESTER RD # 1104
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-3534
Mailing Address - Country:US
Mailing Address - Phone:586-991-3139
Mailing Address - Fax:586-204-0295
Practice Address - Street 1:52188 VAN DYKE AVE STE 201A
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-3569
Practice Address - Country:US
Practice Address - Phone:586-991-3139
Practice Address - Fax:586-204-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care