Provider Demographics
NPI:1053526624
Name:PROCARE HEALING CENTERS, LLP
Entity type:Organization
Organization Name:PROCARE HEALING CENTERS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:DEVILLIERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:405-608-0350
Mailing Address - Street 1:6307 WATERFORD BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-1125
Mailing Address - Country:US
Mailing Address - Phone:405-608-0350
Mailing Address - Fax:405-608-0349
Practice Address - Street 1:2519 S. LAKELINE BOULEVARD
Practice Address - Street 2:UNIT 101
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613
Practice Address - Country:US
Practice Address - Phone:512-249-9498
Practice Address - Fax:512-608-9268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic