Provider Demographics
NPI:1841284353
Name:PROFESSIONAL HOME CARE INC
Entity type:Organization
Organization Name:PROFESSIONAL HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-255-7575
Mailing Address - Street 1:309 N MANDAN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-3886
Mailing Address - Country:US
Mailing Address - Phone:701-255-7575
Mailing Address - Fax:701-255-0699
Practice Address - Street 1:309 N MANDAN ST STE 4
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3886
Practice Address - Country:US
Practice Address - Phone:701-255-7575
Practice Address - Fax:701-255-0699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4038A251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND39486Medicaid
ND12115OtherVETERANS AFFAIRS
ND3947OtherBLUE CROSS
ND56491Medicaid
ND39486Medicaid