Provider Demographics
NPI:1831297019
Name:PROFESSIONAL HEALTHCARE, LLC
Entity Type:Organization
Organization Name:PROFESSIONAL HEALTHCARE, LLC
Other - Org Name:PROFESSIONAL HEALTHCARE, INCORPORATED
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-872-7999
Mailing Address - Street 1:3005 VILLAGE PARK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7993
Mailing Address - Country:US
Mailing Address - Phone:919-872-7999
Mailing Address - Fax:919-872-7090
Practice Address - Street 1:3005 VILLAGE PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-7993
Practice Address - Country:US
Practice Address - Phone:919-872-7999
Practice Address - Fax:919-872-7090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3377251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7100586Medicaid
NC3418157Medicaid