MEDICARE: PROFESSIONAL SERVICES OF HOLY CROSS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WD0400X	Diabetes Educator Registered Nurse

General Provider Information

NPI Number	:	1053053447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL SERVICES OF HOLY CROSS

Provider Business Mailing Address
First Line	:	PO BOX 531863
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30353-1863
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10720 COLUMBIA PIKE STE 300
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20901-4455
Country	:	US
Telephone Number	:	301-557-1231
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	ANNE GILLIS
Credential	:
Telephone Number	:	301-754-7035

Provider Enumeration Date	:	04/07/2022
Last Update Date	:	04/07/2022

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