Provider Demographics
NPI:1073675450
Name:PROFESSIONAL HOME CARE, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CERRA
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 1:222 ELMIRA RD
Practice Address - Street 2:SUITE 4
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5349
Practice Address - Country:US
Practice Address - Phone:607-257-1425
Practice Address - Fax:607-257-1389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01762014Medicaid