Provider Demographics
NPI:1609105444
Name:PROFESSIONAL HEALTH SVC
Entity Type:Organization
Organization Name:PROFESSIONAL HEALTH SVC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-505-6747
Mailing Address - Street 1:PO BOX 26062
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-1062
Mailing Address - Country:US
Mailing Address - Phone:864-242-1747
Mailing Address - Fax:864-370-1201
Practice Address - Street 1:1007 PENDLETON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-2315
Practice Address - Country:US
Practice Address - Phone:864-242-1747
Practice Address - Fax:864-370-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-07
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR40622163W00000X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty