Provider Demographics
NPI:1124448253
Name:PROCARE
Entity type:Organization
Organization Name:PROCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ISMAILA
Authorized Official - Middle Name:
Authorized Official - Last Name:ODUBENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-606-4620
Mailing Address - Street 1:1705 SHAMROCK AVE
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-5302
Mailing Address - Country:US
Mailing Address - Phone:240-606-4620
Mailing Address - Fax:
Practice Address - Street 1:1705 SHAMROCK AVE
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-5302
Practice Address - Country:US
Practice Address - Phone:240-606-4620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle