Healthcare Provider Details

I. General information

NPI: 1841284353
Provider Name (Legal Business Name): PROFESSIONAL HOME CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 01/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 N MANDAN ST STE 4
BISMARCK ND
58501-3886
US

IV. Provider business mailing address

309 N MANDAN ST STE 4
BISMARCK ND
58501-3886
US

V. Phone/Fax

Practice location:
  • Phone: 701-255-7575
  • Fax: 701-255-0699
Mailing address:
  • Phone: 701-255-7575
  • Fax: 701-255-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number4038A
License Number StateND

VIII. Authorized Official

Name: MRS. JOANN FERRIE
Title or Position: DIRECTOR/OWNER
Credential:
Phone: 701-255-7575