Organization
PROCARE HOMES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD KAMOTHO (ADMINISTRATOR)
(714) 232-5384
Entity
Organization
Contact information
Practice address
3842 W STATE AVE, PHOENIX, AZ 85051-8265
(714) 232-5384
Mailing address
11972 GADWALL DR, JURUPA VALLEY, CA 91752-2941
(714) 232-5384
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH7842
AZDHS
AZ
Enumeration date
09/26/2022
Last updated
09/26/2022
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