Provider Demographics
NPI:1750363065
Name:PROFESSIONAL HOME CARE SERVICES, INC.
Entity type:Organization
Organization Name:PROFESSIONAL HOME CARE SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-879-6137
Mailing Address - Street 1:PO BOX 418711 SUITE 700
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8711
Mailing Address - Country:US
Mailing Address - Phone:800-879-6137
Mailing Address - Fax:
Practice Address - Street 1:106 SEBETHE DR STE A
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-1094
Practice Address - Country:US
Practice Address - Phone:860-632-3600
Practice Address - Fax:860-632-5707
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIOSCRIP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251F00000X, 332B00000X, 332BP3500X, 3336C0004X, 3336M0002X, 3336S0011X, 3336H0001X
CT1879333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251F00000XAgenciesHome Infusion
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPCY.0001879OtherPHARMACY
0718455OtherNCPDP
FP0042654OtherDEA
CTPCY.0001879OtherPHARMACY
CT0245180002Medicare NSC
RIPHN10052OtherLICENSE
CT5500000090Medicaid