Provider Demographics
NPI:1164498580
Name:PROFESSIONAL HOME HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:PROFESSIONAL HOME HEALTH SERVICES INC.
Other - Org Name:PROFESSIONAL HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WATCHOUS
Authorized Official - Suffix:
Authorized Official - Credentials:MN, RN
Authorized Official - Phone:785-625-0055
Mailing Address - Street 1:1307 LAWRENCE DR
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2626
Mailing Address - Country:US
Mailing Address - Phone:785-625-0055
Mailing Address - Fax:
Practice Address - Street 1:1307 LAWRENCE DR
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2626
Practice Address - Country:US
Practice Address - Phone:785-625-0055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA026007251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS064OtherBCBS ID NUMBER
KSA026007OtherSTATE ID
KS064OtherBCBS ID NUMBER