Provider Demographics
NPI:1598538910
Name:PROFESSIONAL HEALTHCARE, LLC
Entity Type:Organization
Organization Name:PROFESSIONAL HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-427-8787
Mailing Address - Street 1:3005 VILLAGE PARK DR STE 101
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7993
Mailing Address - Country:US
Mailing Address - Phone:919-872-7999
Mailing Address - Fax:
Practice Address - Street 1:581 EXECUTIVE PL STE 700
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5701
Practice Address - Country:US
Practice Address - Phone:910-427-8787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care