Provider Demographics
NPI:1629105846
Name:PROFESSIONAL HOME CARE INC.
Entity Type:Organization
Organization Name:PROFESSIONAL HOME CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:CERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-763-5616
Mailing Address - Street 1:4401 VESTAL PKWY E
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-3514
Mailing Address - Country:US
Mailing Address - Phone:607-763-5600
Mailing Address - Fax:607-763-5799
Practice Address - Street 1:4401 VESTAL PKWY E
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3514
Practice Address - Country:US
Practice Address - Phone:607-763-5600
Practice Address - Fax:607-763-5799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0233093336C0003X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3328071OtherNCPDP PHARMACY NUMBER
NY01762014Medicaid