Provider Demographics
NPI:1699052019
Name:PROCARE CLINICAL SERVICE
Entity type:Organization
Organization Name:PROCARE CLINICAL SERVICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SANYALE
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:718-282-0777
Mailing Address - Street 1:548 LINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-3052
Mailing Address - Country:US
Mailing Address - Phone:718-282-0777
Mailing Address - Fax:718-282-2727
Practice Address - Street 1:548 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3052
Practice Address - Country:US
Practice Address - Phone:718-282-0777
Practice Address - Fax:718-282-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health