Provider Demographics
NPI:1962400929
Name:PERSONAL HOME HEALTH SERVICES, INC
Entity type:Organization
Organization Name:PERSONAL HOME HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCOUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-658-1383
Mailing Address - Street 1:10 NATE WHIPPLE HWY
Mailing Address - Street 2:STE 9
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-1415
Mailing Address - Country:US
Mailing Address - Phone:401-658-1383
Mailing Address - Fax:401-658-0384
Practice Address - Street 1:10 NATE WHIPPLE HWY
Practice Address - Street 2:STE 9
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-1415
Practice Address - Country:US
Practice Address - Phone:401-658-1383
Practice Address - Fax:401-658-0384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIHCP02419251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPH16333Medicaid
RIPH18712Medicaid