Provider Demographics
NPI:1043352529
Name:PROFESSIONAL HEALTHCARE STAFFING INC
Entity type:Organization
Organization Name:PROFESSIONAL HEALTHCARE STAFFING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:STRUCK
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINSTRATOR
Authorized Official - Phone:702-362-0711
Mailing Address - Street 1:2820 W. CHARLESTON BLVD.
Mailing Address - Street 2:SUITE # 36
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102
Mailing Address - Country:US
Mailing Address - Phone:702-362-0711
Mailing Address - Fax:702-362-8222
Practice Address - Street 1:2820 W CHARLESTON BLVD
Practice Address - Street 2:SUITE # 36
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1942
Practice Address - Country:US
Practice Address - Phone:702-362-0711
Practice Address - Fax:702-362-8222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV603HHA-13251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003002305Medicaid