1073690491 NPI number — PROFESSIONAL HOME SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073690491 NPI number — PROFESSIONAL HOME SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFESSIONAL HOME SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073690491
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6001 NW 153RD ST
Provider Second Line Business Mailing Address:
SUITE 152
Provider Business Mailing Address City Name:
MIAMI LAKES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33014-2419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-827-1211
Provider Business Mailing Address Fax Number:
305-827-1320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6001 NW 153RD ST
Provider Second Line Business Practice Location Address:
SUITE 152
Provider Business Practice Location Address City Name:
MIAMI LAKES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33014-2419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-827-1211
Provider Business Practice Location Address Fax Number:
305-827-1320
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRILLO
Authorized Official First Name:
REBECA
Authorized Official Middle Name:
NUNEZ
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
305-827-1211

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  209740961 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 650884700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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