Provider Demographics
NPI:1912241159
Name:PROFESSIONAL HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BELLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-530-5492
Mailing Address - Street 1:1629 HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-2219
Mailing Address - Country:US
Mailing Address - Phone:720-494-0190
Mailing Address - Fax:720-864-2839
Practice Address - Street 1:3495 WADSWORTH BLVD STE 400
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-0000
Practice Address - Country:US
Practice Address - Phone:303-368-1999
Practice Address - Fax:303-368-8221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-10
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO77455835Medicaid
CO77455835Medicaid