Provider Demographics
NPI:1437991908
Name:PROCARE HEALING CENTERS, LLC
Entity type:Organization
Organization Name:PROCARE HEALING CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRENTON
Authorized Official - Middle Name:
Authorized Official - Last Name:STILLWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-313-0001
Mailing Address - Street 1:3501 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-2138
Mailing Address - Country:US
Mailing Address - Phone:866-306-4461
Mailing Address - Fax:405-300-1336
Practice Address - Street 1:3501 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-2138
Practice Address - Country:US
Practice Address - Phone:866-306-4461
Practice Address - Fax:405-300-1336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-06
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty