Organization
PROCTORS PROVISION LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIAH TA'SHEA PROCTOR (OWNER/CEO)
(573) 814-8528
Entity
Organization
Contact information
Practice address
1809 VANDIVER DR STE 105, COLUMBIA, MO 65202-3948
(573) 814-8528
Mailing address
1809 VANDIVER DR STE 105, COLUMBIA, MO 65202-3948
(573) 814-8528
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
10/26/2020
Last updated
10/26/2020
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