Provider Demographics
NPI:1033462759
Name:PROFESSIONAL RESPIRATORY HOMECARE SERVICES, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL RESPIRATORY HOMECARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:ASMAMAW
Authorized Official - Middle Name:E
Authorized Official - Last Name:BEYENE
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:410-790-4899
Mailing Address - Street 1:2520 LORD BALTIMORE DR STE U
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2670
Mailing Address - Country:US
Mailing Address - Phone:410-281-0002
Mailing Address - Fax:410-281-0009
Practice Address - Street 1:2520 LORD BALTIMORE DR STE U
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2670
Practice Address - Country:US
Practice Address - Phone:410-281-0002
Practice Address - Fax:410-281-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3307332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies