Provider Demographics
NPI:1124466925
Name:PROCARE HOME MEDICAL, INC.
Entity type:Organization
Organization Name:PROCARE HOME MEDICAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SYCKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-697-1892
Mailing Address - Street 1:4215 CREDIT UNION DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-6659
Mailing Address - Country:US
Mailing Address - Phone:907-274-0770
Mailing Address - Fax:907-274-0773
Practice Address - Street 1:915 30TH AVE STE 106
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7577
Practice Address - Country:US
Practice Address - Phone:907-458-8912
Practice Address - Fax:907-458-8914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-13
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMS9610Medicaid
AKMS9610Medicaid