Provider Demographics
NPI:1366588147
Name:PROCARE HOME CARE AGENCY
Entity type:Organization
Organization Name:PROCARE HOME CARE AGENCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUFEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OWOSENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-712-6956
Mailing Address - Street 1:7924 PRESTON RD
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2301
Mailing Address - Country:US
Mailing Address - Phone:972-712-6956
Mailing Address - Fax:972-712-4454
Practice Address - Street 1:7924 PRESTON RD
Practice Address - Street 2:SUITE 100A
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2301
Practice Address - Country:US
Practice Address - Phone:972-712-6956
Practice Address - Fax:972-712-4454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing CareGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1012925Medicaid
TX1013870Medicaid
TX1013077Medicaid
TX1013077Medicaid