Healthcare Provider Details

I. General information

NPI: 1962400929
Provider Name (Legal Business Name): PERSONAL HOME HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 NATE WHIPPLE HWY STE 9
CUMBERLAND RI
02864-1415
US

IV. Provider business mailing address

10 NATE WHIPPLE HWY STE 9
CUMBERLAND RI
02864-1415
US

V. Phone/Fax

Practice location:
  • Phone: 401-658-1383
  • Fax: 401-658-0384
Mailing address:
  • Phone: 401-658-1383
  • Fax: 401-658-0384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCP02419
License Number StateRI

VIII. Authorized Official

Name: SUZANNE MARCOUX
Title or Position: PRESIDENT
Credential:
Phone: 401-658-1383