Provider Demographics
NPI:1891952610
Name:PROFESSIONAL CARETAKERS INC.
Entity Type:Organization
Organization Name:PROFESSIONAL CARETAKERS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-921-9500
Mailing Address - Street 1:6050 HARRIS PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4102
Mailing Address - Country:US
Mailing Address - Phone:817-921-9500
Mailing Address - Fax:817-921-9576
Practice Address - Street 1:6050 HARRIS PKWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4102
Practice Address - Country:US
Practice Address - Phone:817-921-9500
Practice Address - Fax:817-921-9576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008343251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health