Provider Demographics
NPI:1588089924
Name:PROFESSIONAL HEALTHCARE SOLUTIONS
Entity type:Organization
Organization Name:PROFESSIONAL HEALTHCARE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KERRENA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-990-0650
Mailing Address - Street 1:466 NORTHFIELD RD # LL
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-2287
Mailing Address - Country:US
Mailing Address - Phone:144-025-2711
Mailing Address - Fax:
Practice Address - Street 1:10333 NORTHFIELD RD UNIT 74D
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44067-1471
Practice Address - Country:US
Practice Address - Phone:330-990-0650
Practice Address - Fax:330-777-8520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0397738Medicaid