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General NPI Number Information
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NPI Number | 1194195370
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PICC SERVICES LLC
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Dates
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Enumeration Date | 10/01/2015
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Last Update Date | 10/01/2015
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Provider Practice Location Address
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Address Line | 115 WOODVIEW DR
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City | CORTLAND
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State | OH
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Zip | 44410-1247
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Country | US
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Telephone | 330-637-1940
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Fax | 440-259-1055
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Provider Business Mailing Address
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Address Line | 115 WOODVIEW DR
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City | CORTLAND
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State | OH
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Zip | 44410-1247
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Country | US
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Telephone | 330-637-1940
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Fax | 440-259-1055
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. DAVID A. DAVIS
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Credential |
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Telephone | 330-637-1940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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