Provider Demographics
NPI:1740637883
Name:PROFESSIONAL HEALTH CARE SERVICES, INC.
Entity type:Organization
Organization Name:PROFESSIONAL HEALTH CARE SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HOME CARE
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:PRESTON
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:540-265-2194
Mailing Address - Street 1:367 HERSHBERGER RD., NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012
Mailing Address - Country:US
Mailing Address - Phone:540-265-2194
Mailing Address - Fax:540-265-2254
Practice Address - Street 1:367 HERSHBERGER RD., NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012
Practice Address - Country:US
Practice Address - Phone:540-265-2194
Practice Address - Fax:540-265-2254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHCO-1695OtherVIRGINIA DEPT. OF HEALTH