Provider Demographics
NPI:1831569425
Name:PROFESSIONAL HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:PROFESSIONAL HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SEMEIKO
Authorized Official - Middle Name:BAKER
Authorized Official - Last Name:GAMBRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-238-9888
Mailing Address - Street 1:15207 CARROLLTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:VA
Mailing Address - Zip Code:23314-2303
Mailing Address - Country:US
Mailing Address - Phone:757-238-9888
Mailing Address - Fax:757-238-9920
Practice Address - Street 1:15207 CARROLLTON BLVD
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:VA
Practice Address - Zip Code:23314-2303
Practice Address - Country:US
Practice Address - Phone:757-238-9888
Practice Address - Fax:757-238-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-25
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-161063385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care