Provider Demographics
NPI:1548587751
Name:PROFESSIONAL NURSES HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL NURSES HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:NDEITHI
Authorized Official - Last Name:GATHERU
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:508-363-0889
Mailing Address - Street 1:425 SUNDERLAND RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-2046
Mailing Address - Country:US
Mailing Address - Phone:503-363-0889
Mailing Address - Fax:508-363-0885
Practice Address - Street 1:425 SUNDERLAND RD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-2046
Practice Address - Country:US
Practice Address - Phone:503-363-0889
Practice Address - Fax:508-363-0885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAT458251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care