Provider Demographics
NPI:1114184033
Name:PROFESSIONAL HOME HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:PROFESSIONAL HOME HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP SR DIRECTOR BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-205-2440
Mailing Address - Street 1:620 FREEDOM BUSINESS CTR DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1330
Mailing Address - Country:US
Mailing Address - Phone:610-205-2440
Mailing Address - Fax:610-205-2468
Practice Address - Street 1:21309 BERLIN RD
Practice Address - Street 2:SUSSEX SUITES, UNIT 9
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-3185
Practice Address - Country:US
Practice Address - Phone:302-855-0310
Practice Address - Fax:302-855-0840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEHHAS 028251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000768314Medicaid
DE087034Medicare Oscar/Certification