Provider Demographics
NPI:1215084900
Name:PROFESSIONAL HEALTHCARE RESOURCES OF MARYLAND, INC.
Entity type:Organization
Organization Name:PROFESSIONAL HEALTHCARE RESOURCES OF MARYLAND, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP-FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLEMENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-752-8700
Mailing Address - Street 1:7619 LITTLE RIVER TPKE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2625
Mailing Address - Country:US
Mailing Address - Phone:703-752-8700
Mailing Address - Fax:703-872-8779
Practice Address - Street 1:10605 CONCORD ST
Practice Address - Street 2:SUITE 309
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2504
Practice Address - Country:US
Practice Address - Phone:240-395-0000
Practice Address - Fax:240-395-0001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDHH7154251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD217154Medicare ID - Type UnspecifiedHOME HEALTH