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General NPI Number Information
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NPI Number | 1831445758
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL HEALTH SERVICE LLC
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Dates
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Enumeration Date | 07/29/2012
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Last Update Date | 07/29/2012
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Provider Practice Location Address
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Address Line | 940 S GRAND TRAVERSE ST SUITE C
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City | FLINT
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State | MI
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Zip | 48502-1059
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Country | US
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Telephone | 810-610-5942
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Fax |
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Provider Business Mailing Address
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Address Line | 11426 DAVIS ST SUITE 1145
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City | GRAND BLANC
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State | MI
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Zip | 48480-8500
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Country | US
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Telephone | 810-610-5942
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | MISS CASSANDRA RENE PRESSLEY
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Credential | RN
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Telephone | 810-610-5942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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