Provider Demographics
NPI:1932505245
Name:PROFESSIONAL COMFORT CARE
Entity Type:Organization
Organization Name:PROFESSIONAL COMFORT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED AGENCY
Authorized Official - Phone:785-393-2689
Mailing Address - Street 1:1008 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3752
Mailing Address - Country:US
Mailing Address - Phone:785-218-9436
Mailing Address - Fax:
Practice Address - Street 1:1008 WILDWOOD DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3752
Practice Address - Country:US
Practice Address - Phone:785-218-9436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHERRY BOLDEN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA023015251E00000X
A023015251S00000X
KS251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health