Provider Demographics
NPI:1821507070
Name:PROFESSIONAL HEALTH SERVICE, LLC
Entity Type:Organization
Organization Name:PROFESSIONAL HEALTH SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:ACKLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-967-7991
Mailing Address - Street 1:48 SUNRISE PARK
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2345
Mailing Address - Country:US
Mailing Address - Phone:931-967-7991
Mailing Address - Fax:931-967-9829
Practice Address - Street 1:48 SUNRISE PARK
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2345
Practice Address - Country:US
Practice Address - Phone:931-967-7991
Practice Address - Fax:931-967-9829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN491332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN491OtherTN OFFICE OF HEALTH CARE FACILITIES