Provider Demographics
NPI:1639175193
Name:PROMED PERSONNEL SERVICES, INC.
Entity Type:Organization
Organization Name:PROMED PERSONNEL SERVICES, INC.
Other - Org Name:PROMED HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILOU
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGULLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-626-1644
Mailing Address - Street 1:4615 SOUTHWEST FWY
Mailing Address - Street 2:STE 725
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7116
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:713-626-2441
Practice Address - Street 1:4615 SOUTHWEST FWY
Practice Address - Street 2:STE 725
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7116
Practice Address - Country:US
Practice Address - Phone:713-626-1644
Practice Address - Fax:713-626-2441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX006980251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-9479Medicare ID - Type Unspecified