Provider Demographics
NPI:1891080297
Name:PHYSICIANS HOMECARE SERVICES INC
Entity Type:Organization
Organization Name:PHYSICIANS HOMECARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KUNLE
Authorized Official - Middle Name:G
Authorized Official - Last Name:FAJANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-735-3280
Mailing Address - Street 1:390 MAIN ST
Mailing Address - Street 2:SUITE 509
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-2583
Mailing Address - Country:US
Mailing Address - Phone:508-735-3280
Mailing Address - Fax:508-753-1974
Practice Address - Street 1:390 MAIN ST
Practice Address - Street 2:SUITE 509
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-2583
Practice Address - Country:US
Practice Address - Phone:508-735-3280
Practice Address - Fax:508-753-1974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health