Provider Demographics
NPI:1720014491
Name:PROFESSIONAL HOME CARE
Entity Type:Organization
Organization Name:PROFESSIONAL HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-698-0797
Mailing Address - Street 1:2000 HARRISON ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7442
Mailing Address - Country:US
Mailing Address - Phone:870-698-0797
Mailing Address - Fax:870-698-1057
Practice Address - Street 1:2000 HARRISON ST
Practice Address - Street 2:SUITE E
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7442
Practice Address - Country:US
Practice Address - Phone:870-698-0797
Practice Address - Fax:870-698-1057
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:APPROVE HOME MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-24
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR251E00000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR216809514Medicaid
AR117212732Medicaid
AR117211514Medicaid
AR187290742Medicaid
AR117210738Medicaid
AR136203765Medicaid
AR17118OtherBLUE CROSS
AR135909752Medicaid
AR135910757Medicaid