Provider Demographics
NPI:1306201827
Name:PROFESSIONAL HOME CARE SPECIALISTS LLC
Entity Type:Organization
Organization Name:PROFESSIONAL HOME CARE SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:MICHAUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-764-3866
Mailing Address - Street 1:1086 MAPLETON RD
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:ME
Mailing Address - Zip Code:04757-4508
Mailing Address - Country:US
Mailing Address - Phone:207-764-3866
Mailing Address - Fax:
Practice Address - Street 1:1086 MAPLETON RD
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:ME
Practice Address - Zip Code:04757-4508
Practice Address - Country:US
Practice Address - Phone:207-764-3866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care