Healthcare Provider Details

I. General information

NPI: 1982699252
Provider Name (Legal Business Name): PROFESSIONAL HOME CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 RIVERSIDE DR
JOHNSON CITY NY
13790-2544
US

IV. Provider business mailing address

601 RIVERSIDE DR
JOHNSON CITY NY
13790-2544
US

V. Phone/Fax

Practice location:
  • Phone: 607-763-5600
  • Fax: 607-763-5582
Mailing address:
  • Phone: 607-763-5600
  • Fax: 607-763-5582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number0055L001
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0055L001
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0055L001
License Number StateNY

VIII. Authorized Official

Name: MR. GREG RITTENHOUSE
Title or Position: PRESIDENT CEO
Credential:
Phone: 607-763-5600