Provider Demographics
NPI:1619651940
Name:ACCESS PROFESSIONAL HOME CARE SERVICES, LLC
Entity Type:Organization
Organization Name:ACCESS PROFESSIONAL HOME CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-906-5421
Mailing Address - Street 1:3706 MORMON ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68112-2043
Mailing Address - Country:US
Mailing Address - Phone:402-906-5421
Mailing Address - Fax:
Practice Address - Street 1:3706 MORMON ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68112-2043
Practice Address - Country:US
Practice Address - Phone:402-906-5421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE32031397Medicaid