Provider Demographics
NPI:1912953548
Name:PROFESSIONAL HEALTHCARE RESOURCES, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL HEALTHCARE RESOURCES, INC.
Other - Org Name:PROFESSIONAL HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF REVENUE
Authorized Official - Prefix:
Authorized Official - First Name:ELENI
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIVIZAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-752-8700
Mailing Address - Street 1:7619 LITTLE RIVER TPKE
Mailing Address - Street 2:STE. 600
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2625
Mailing Address - Country:US
Mailing Address - Phone:703-752-8700
Mailing Address - Fax:703-752-8779
Practice Address - Street 1:7619 LITTLE RIVER TPKE
Practice Address - Street 2:STE. 600
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2625
Practice Address - Country:US
Practice Address - Phone:703-752-8700
Practice Address - Fax:703-752-8779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA497502251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4973551Medicaid
VA=========OtherTRICARE
VA497502Medicare ID - Type Unspecified