Healthcare Provider Details

I. General information

NPI: 1578545687
Provider Name (Legal Business Name): PROFESSIONAL HOME CARE SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 NORTH CHARLOTTE STREET
POTTSTOWN PA
19464
US

IV. Provider business mailing address

911 NORTH CHARLOTTE STREET
POTTSTOWN PA
19464
US

V. Phone/Fax

Practice location:
  • Phone: 610-323-8750
  • Fax: 610-326-0850
Mailing address:
  • Phone: 610-323-8750
  • Fax: 610-326-0850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberPP414200L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP414200L
License Number StatePA

VIII. Authorized Official

Name: DR. WALTER CHARLES STIELAU JR.
Title or Position: DIRECTOR
Credential: PHARMD
Phone: 610-323-8750