Provider Demographics
NPI:1871801316
Name:PROFESSIONAL HOME NURSING SERVICES
Entity type:Organization
Organization Name:PROFESSIONAL HOME NURSING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:ANTONIA
Authorized Official - Last Name:RANIA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:781-572-0080
Mailing Address - Street 1:42 WAREHAM STREET
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-6222
Mailing Address - Country:US
Mailing Address - Phone:781-572-0080
Mailing Address - Fax:781-219-4466
Practice Address - Street 1:42 WAREHAM STREET
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-6222
Practice Address - Country:US
Practice Address - Phone:781-572-0080
Practice Address - Fax:781-219-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care