Provider Demographics
NPI:1679843304
Name:PROFESSIONAL ASSISTANT SERVICES
Entity Type:Organization
Organization Name:PROFESSIONAL ASSISTANT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BALTES
Authorized Official - Suffix:
Authorized Official - Credentials:BUSINESS HEALTH CARE
Authorized Official - Phone:949-371-3411
Mailing Address - Street 1:30025 ALICIA PKWY # 199
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2090
Mailing Address - Country:US
Mailing Address - Phone:949-371-3411
Mailing Address - Fax:
Practice Address - Street 1:30025 ALICIA PKWY # 199
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2090
Practice Address - Country:US
Practice Address - Phone:949-371-3411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20116268670251B00000X, 251E00000X, 251V00000X, 253Z00000X
CAF3035105347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251V00000XAgenciesVoluntary or Charitable
No347C00000XTransportation ServicesPrivate Vehicle