Provider Demographics
NPI:1518002591
Name:PROFESSIONAL HOME CARE, INC.
Entity type:Organization
Organization Name:PROFESSIONAL HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AZIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:UDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-294-9220
Mailing Address - Street 1:2920 OAKWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:MELVINDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48122-1244
Mailing Address - Country:US
Mailing Address - Phone:313-294-9220
Mailing Address - Fax:313-294-2747
Practice Address - Street 1:2920 OAKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:MELVINDALE
Practice Address - State:MI
Practice Address - Zip Code:48122-1244
Practice Address - Country:US
Practice Address - Phone:313-294-9220
Practice Address - Fax:313-294-2747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI237488Medicare ID - Type Unspecified