Provider Demographics
NPI:1285092031
Name:PROFESSIONAL MEDICAL HOME CARE, LLC
Entity type:Organization
Organization Name:PROFESSIONAL MEDICAL HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BYS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD,MSN,MPA,RN,LNHA
Authorized Official - Phone:413-301-5353
Mailing Address - Street 1:112 WESTFIELD ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-2577
Mailing Address - Country:US
Mailing Address - Phone:413-301-5353
Mailing Address - Fax:
Practice Address - Street 1:112 WESTFIELD ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-2577
Practice Address - Country:US
Practice Address - Phone:413-301-5353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health