Provider Demographics
NPI:1598814758
Name:PROFESSIONAL HOME CARE SERVICES, LLC
Entity Type:Organization
Organization Name:PROFESSIONAL HOME CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P. OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-395-5100
Mailing Address - Street 1:7600 N 16TH ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4431
Mailing Address - Country:US
Mailing Address - Phone:602-263-5000
Mailing Address - Fax:602-263-5061
Practice Address - Street 1:7600 N 16TH ST
Practice Address - Street 2:SUITE 140
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4431
Practice Address - Country:US
Practice Address - Phone:602-263-5000
Practice Address - Fax:602-263-5061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA1950251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ648165Medicaid
AZ037216Medicare ID - Type UnspecifiedMEDICARE HOME HEALTH PROV