Provider Demographics
NPI:1386647592
Name:PROFESSIONAL HOME NURSING, INC
Entity Type:Organization
Organization Name:PROFESSIONAL HOME NURSING, INC
Other - Org Name:PROFESSIONAL HOME NURSING
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO, CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, MSB
Authorized Official - Phone:207-498-3915
Mailing Address - Street 1:7 HATCH DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-2159
Mailing Address - Country:US
Mailing Address - Phone:207-498-3915
Mailing Address - Fax:207-493-4510
Practice Address - Street 1:7 HATCH DR
Practice Address - Street 2:SUITE 110
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-2159
Practice Address - Country:US
Practice Address - Phone:207-498-3915
Practice Address - Fax:207-493-4510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2655251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME207055017310OtherBLUE CROSS PROVIDER ID
ME128450000Medicaid
ME128450000Medicaid