Provider Demographics
NPI:1700871506
Name:PROFESSIONAL HOME HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:PROFESSIONAL HOME HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT-COMPLIANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:P
Authorized Official - Last Name:ANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-205-2440
Mailing Address - Street 1:620 FREEDOM BUSINESS CTR DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1330
Mailing Address - Country:US
Mailing Address - Phone:610-205-2440
Mailing Address - Fax:610-205-2468
Practice Address - Street 1:2145 S DUPONT HWY
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-5561
Practice Address - Country:US
Practice Address - Phone:302-697-7125
Practice Address - Fax:302-697-7257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000768314Medicaid
DEBB82OtherCAREFIRST
DE2333OtherAETNA
DE243654OtherMAMSI
DE157994OtherFEDERAL BC
MD236383601Medicaid
DE0000045714Medicaid
DE0004963000OtherKEYSTONE HEALTH PLAN EAST
DE1058OtherMIDATLANTIC HEALTH PLAN
DE157994OtherBC/BS OF DELAWARE
DE243654OtherMAMSI