Provider Demographics
NPI:1295396455
Name:CHERRY PROFESSIONA HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:CHERRY PROFESSIONA HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-730-8320
Mailing Address - Street 1:PO BOX 6087
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-8087
Mailing Address - Country:US
Mailing Address - Phone:571-264-9012
Mailing Address - Fax:
Practice Address - Street 1:4514 BRIDLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-8154
Practice Address - Country:US
Practice Address - Phone:571-730-8320
Practice Address - Fax:571-264-9012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No251V00000XAgenciesVoluntary or Charitable
No253Z00000XAgenciesIn Home Supportive Care
No282J00000XHospitalsReligious Nonmedical Health Care Institution
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service
No251J00000XAgenciesNursing Care