Provider Demographics
NPI:1518738053
Name:PROFESSIONAL HOME CARE SERVICE LLC.
Entity Type:Organization
Organization Name:PROFESSIONAL HOME CARE SERVICE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMRALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-541-8021
Mailing Address - Street 1:18121 E 8 MILE RD STE 207
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3243
Mailing Address - Country:US
Mailing Address - Phone:586-541-8021
Mailing Address - Fax:586-541-8025
Practice Address - Street 1:18121 E 8 MILE RD STE 207
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3243
Practice Address - Country:US
Practice Address - Phone:586-541-8021
Practice Address - Fax:586-541-8025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care