Provider Demographics
NPI:1700641164
Name:PETERSONS PROFESSIONAL SERVICES LLC
Entity Type:Organization
Organization Name:PETERSONS PROFESSIONAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:567-333-1298
Mailing Address - Street 1:1126 MARIANNA DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-9672
Mailing Address - Country:US
Mailing Address - Phone:567-333-1298
Mailing Address - Fax:419-589-6641
Practice Address - Street 1:1126 MARIANNA DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-9672
Practice Address - Country:US
Practice Address - Phone:567-333-1298
Practice Address - Fax:419-589-6641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty