Healthcare Provider Details

I. General information

NPI: 1932505245
Provider Name (Legal Business Name): PROFESSIONAL COMFORT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 WILDWOOD DR
LAWRENCE KS
66049-3752
US

IV. Provider business mailing address

1008 WILDWOOD DR
LAWRENCE KS
66049-3752
US

V. Phone/Fax

Practice location:
  • Phone: 785-218-9436
  • Fax:
Mailing address:
  • Phone: 785-218-9436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberA023015
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberA023015
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateKS

VIII. Authorized Official

Name: MS. CHERRY BOLDEN
Title or Position: CEO
Credential: CERTIFIED AGENCY
Phone: 785-393-2689