Provider Demographics
NPI:1194195370
Name:PROFESSIONAL PICC SERVICES LLC
Entity Type:Organization
Organization Name:PROFESSIONAL PICC SERVICES LLC
Other - Org Name:PROFESSIONAL DIALYSIS SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-637-1940
Mailing Address - Street 1:115 WOODVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-1247
Mailing Address - Country:US
Mailing Address - Phone:330-637-1940
Mailing Address - Fax:440-259-1055
Practice Address - Street 1:115 WOODVIEW DR
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-1247
Practice Address - Country:US
Practice Address - Phone:330-637-1940
Practice Address - Fax:440-259-1055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility