Provider Demographics
NPI:1447350046
Name:PROCARE PT PLC
Entity type:Organization
Organization Name:PROCARE PT PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-982-8873
Mailing Address - Street 1:2302 COLONIAL AVE SW STE G
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24015-3100
Mailing Address - Country:US
Mailing Address - Phone:540-982-2273
Mailing Address - Fax:540-982-2274
Practice Address - Street 1:2302 COLONIAL AVE SW STE G
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24015-3100
Practice Address - Country:US
Practice Address - Phone:540-982-2273
Practice Address - Fax:540-982-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-23
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1109362305005536174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09192Medicare PIN