Provider Demographics
NPI:1619967619
Name:PROFESSIONAL HOME CARE ASSOCIATES
Entity Type:Organization
Organization Name:PROFESSIONAL HOME CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-377-7699
Mailing Address - Street 1:2296 COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-5315
Mailing Address - Country:US
Mailing Address - Phone:510-797-9299
Mailing Address - Fax:
Practice Address - Street 1:2296 COUNTRY DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-5315
Practice Address - Country:US
Practice Address - Phone:510-797-9299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA.251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA557290Medicare ID - Type UnspecifiedMEDICARE ID NUMBER