Provider Demographics
NPI:1952713117
Name:PRO HEALTHCARE SERVICING, LLC
Entity Type:Organization
Organization Name:PRO HEALTHCARE SERVICING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:SALE
Authorized Official - Last Name:COREY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:703-431-3202
Mailing Address - Street 1:1320 CENTRAL PARK BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4942
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1320 CENTRAL PARK BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4942
Practice Address - Country:US
Practice Address - Phone:703-352-1939
Practice Address - Fax:703-352-2294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-22
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO11592251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA497656Medicare Oscar/Certification