Provider Demographics
NPI:1063457505
Name:PROFESSIONAL SKILLED SERVICES, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL SKILLED SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNA
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:956-712-2190
Mailing Address - Street 1:205 W VILLAGE BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2261
Mailing Address - Country:US
Mailing Address - Phone:956-712-2190
Mailing Address - Fax:956-712-0147
Practice Address - Street 1:205 W VILLAGE BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2261
Practice Address - Country:US
Practice Address - Phone:956-712-2190
Practice Address - Fax:956-712-0147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008762251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX459203Medicare Oscar/Certification