Provider Demographics
NPI:1598128779
Name:BAL PROFESSIONAL HEALTHCARE SERVICES INC
Entity Type:Organization
Organization Name:BAL PROFESSIONAL HEALTHCARE SERVICES INC
Other - Org Name:BAL COMPREHENSIVE OUTPATIENT REHABILITAITON FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-763-6722
Mailing Address - Street 1:155 WESTRIDGE PKWY
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3049
Mailing Address - Country:US
Mailing Address - Phone:678-782-5400
Mailing Address - Fax:678-782-3330
Practice Address - Street 1:155 WESTRIDGE PKWY
Practice Address - Street 2:SUITE 208
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3049
Practice Address - Country:US
Practice Address - Phone:678-782-5400
Practice Address - Fax:678-782-3330
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:I-CARE PRIVATE HOME CARE SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA075-R-0832251C00000X, 261QR0401X
261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care