Provider Demographics
NPI:1275353872
Name:PROACTIVE HOMECARE
Entity type:Organization
Organization Name:PROACTIVE HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EBERSON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:689-217-3370
Mailing Address - Street 1:4700 MILLENIA BLVD STE 175
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-6015
Mailing Address - Country:US
Mailing Address - Phone:689-217-3370
Mailing Address - Fax:
Practice Address - Street 1:4700 MILLENIA BLVD STE 175
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-6015
Practice Address - Country:US
Practice Address - Phone:689-217-3370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health