Provider Demographics
NPI:1639476013
Name:COMPREHENSIVE HOME CARE PROFESSIONALS,INC
Entity Type:Organization
Organization Name:COMPREHENSIVE HOME CARE PROFESSIONALS,INC
Other - Org Name:PSYCHIATRIST OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EWA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:760-861-0276
Mailing Address - Street 1:889 E FRANCIS DR
Mailing Address - Street 2:PO BOX 944
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-2213
Mailing Address - Country:US
Mailing Address - Phone:760-861-0276
Mailing Address - Fax:769-668-0818
Practice Address - Street 1:889 E FRANCIS DR
Practice Address - Street 2:PO BOC 944
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-2213
Practice Address - Country:US
Practice Address - Phone:760-861-0276
Practice Address - Fax:760-668-0818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-19
Last Update Date:2011-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC2241978251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC50525Medicare UPIN
CA00C501870Medicare PIN