Provider Demographics
NPI:1619134533
Name:PROFESSIONAL HOME HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:PROFESSIONAL HOME HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR CORP DIRECTOR BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-205-2440
Mailing Address - Street 1:620 FREEDOM BUSINESS CTR DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1330
Mailing Address - Country:US
Mailing Address - Phone:610-205-2440
Mailing Address - Fax:610-205-2468
Practice Address - Street 1:107 CHESAPEAKE BLVD
Practice Address - Street 2:SUITE 114
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6390
Practice Address - Country:US
Practice Address - Phone:410-398-4733
Practice Address - Fax:410-620-2723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20586251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD004500400Medicaid
MD004500400Medicaid