MEDICARE: PROFESSIONAL HOME CARE SOLUTIONS, INC

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1134600240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL HOME CARE SOLUTIONS, INC

Provider Business Mailing Address
First Line	:	PO BOX 550912
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32255-0912
Country	:	US
Telephone Number	:	904-316-8413
Fax Number	:

Provider Business Practice Location Address
First Line	:	3104 HIDDEN LAKE CV
Second Line	:
City	:	MIDDLEBURG
State	:	FL
Zip	:	32068-8256
Country	:	US
Telephone Number	:	904-316-8413
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TERRI POWELL
Credential	:
Telephone Number	:	904-316-8413

Provider Enumeration Date	:	08/27/2018
Last Update Date	:	08/30/2019

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