Provider Demographics
NPI:1033526330
Name:PROFESSIONAL HOME CARE INC
Entity Type:Organization
Organization Name:PROFESSIONAL HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT & COO
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:RITTENHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-763-5600
Mailing Address - Street 1:601 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2544
Mailing Address - Country:US
Mailing Address - Phone:607-763-5600
Mailing Address - Fax:607-763-5582
Practice Address - Street 1:26 CONKEY AVE
Practice Address - Street 2:1ST FLOOR EATON CENTER
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1756
Practice Address - Country:US
Practice Address - Phone:607-336-5130
Practice Address - Fax:607-336-5131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-18
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0055L001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01762014Medicaid