1033526330 NPI number — PROFESSIONAL HOME CARE INC

Table of content: (NPI 1033526330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033526330 NPI number — PROFESSIONAL HOME CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFESSIONAL HOME CARE 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:
1033526330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 RIVERSIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOHNSON CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13790-2544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-763-5600
Provider Business Mailing Address Fax Number:
607-763-5582

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26 CONKEY AVE
Provider Second Line Business Practice Location Address:
1ST FLOOR EATON CENTER
Provider Business Practice Location Address City Name:
NORWICH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13815-1756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-336-5130
Provider Business Practice Location Address Fax Number:
607-336-5131
Provider Enumeration Date:
07/18/2014

Additional Information

Authorized Official

Authorized Official Last Name:
RITTENHOUSE
Authorized Official First Name:
GREG
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE-PRESIDENT & COO
Authorized Official Telephone Number:
607-763-5600

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0055L001 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01762014 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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