1700871506 NPI number — PROFESSIONAL HOME HEALTH SERVICES, INC

Table of content: (NPI 1700871506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700871506 NPI number — PROFESSIONAL HOME HEALTH SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFESSIONAL HOME HEALTH 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:
1700871506
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
620 FREEDOM BUSINESS CTR DR
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
KING OF PRUSSIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19406-1330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-205-2440
Provider Business Mailing Address Fax Number:
610-205-2468

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2145 S DUPONT HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19901-5561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-697-7125
Provider Business Practice Location Address Fax Number:
302-697-7257
Provider Enumeration Date:
09/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ANGELO
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
P
Authorized Official Title or Position:
VICE PRESIDENT-COMPLIANCE
Authorized Official Telephone Number:
610-205-2440

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0000768314 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: BB82 . This is a "CAREFIRST" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 2333 . This is a "AETNA" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 243654 . This is a "MAMSI" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 157994 . This is a "FEDERAL BC" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 236383601 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000045714 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0004963000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 1058 . This is a "MIDATLANTIC HEALTH PLAN" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 157994 . This is a "BC/BS OF DELAWARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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