Provider Demographics
NPI:1700070679
Name:PHYSICIAN HOME CARE SERVICES, INC.
Entity Type:Organization
Organization Name:PHYSICIAN HOME CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VASANTH
Authorized Official - Middle Name:GLADSON
Authorized Official - Last Name:STEPHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-528-7427
Mailing Address - Street 1:121 FAIRFIELD WAY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1588
Mailing Address - Country:US
Mailing Address - Phone:630-529-7427
Mailing Address - Fax:630-529-9937
Practice Address - Street 1:121 FAIRFIELD WAY
Practice Address - Street 2:SUITE 207
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1588
Practice Address - Country:US
Practice Address - Phone:630-529-7427
Practice Address - Fax:630-529-9937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty