Provider Demographics
NPI:1356344733
Name:PRO-CARE HOME HEALTH LIMITED
Entity type:Organization
Organization Name:PRO-CARE HOME HEALTH LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF INFORMATION SYSTEMS
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-298-3112
Mailing Address - Street 1:PO BOX 109
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:KY
Mailing Address - Zip Code:42347-0109
Mailing Address - Country:US
Mailing Address - Phone:270-298-3112
Mailing Address - Fax:270-298-4766
Practice Address - Street 1:122 W UNION ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:KY
Practice Address - Zip Code:42347-1416
Practice Address - Country:US
Practice Address - Phone:270-298-3112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
273Y00000X
KY150138251B00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No273Y00000XHospital UnitsRehabilitation Unit
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY34000265Medicaid
KY45003522OtherKY EPSDT
KY42000158OtherWAIVER
KY42000158OtherWAIVER