Provider Demographics
NPI:1639565682
Name:PROFESSIONAL HEARING SOLUTIONS,LLC
Entity Type:Organization
Organization Name:PROFESSIONAL HEARING SOLUTIONS,LLC
Other - Org Name:MIRACLE EAR CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRIVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-476-9949
Mailing Address - Street 1:PO BOX 733
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:PA
Mailing Address - Zip Code:18444-0733
Mailing Address - Country:US
Mailing Address - Phone:570-476-9949
Mailing Address - Fax:570-421-6038
Practice Address - Street 1:1619 N 9TH ST
Practice Address - Street 2:STROUD COMMONS
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-6501
Practice Address - Country:US
Practice Address - Phone:570-476-9949
Practice Address - Fax:570-421-6038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAD01013332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment