Provider Demographics
NPI:1912620220
Name:PROFESSIONAL NURSING HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:PROFESSIONAL NURSING HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUN
Authorized Official - Middle Name:
Authorized Official - Last Name:THANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-999-7905
Mailing Address - Street 1:3535 ROCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-6142
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1910 INWOOD DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-6142
Practice Address - Country:US
Practice Address - Phone:260-999-7905
Practice Address - Fax:260-999-7564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care