Provider Demographics
NPI:1265776801
Name:PROFESSIONAL SERVICE GROUP PSG
Entity type:Organization
Organization Name:PROFESSIONAL SERVICE GROUP PSG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LURONE
Authorized Official - Middle Name:
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:423-266-1384
Mailing Address - Street 1:200 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37410-1317
Mailing Address - Country:US
Mailing Address - Phone:423-266-1384
Mailing Address - Fax:423-756-3557
Practice Address - Street 1:200 W 38TH ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37410-1317
Practice Address - Country:US
Practice Address - Phone:423-266-1384
Practice Address - Fax:423-756-3557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1000000011801251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health