Basic Information
| Provider Information | |||||||||
| NPI: | 1073761839 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEALTH SERVICES PERSONNEL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HSP | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9901 LINN STATION RD | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402233808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008660860 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 233 E MODLIN RD | ||||||||
| Address2: | |||||||||
| City: | AHOSKIE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279108220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008660860 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2008 | ||||||||
| LastUpdateDate: | 09/05/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | OMBRES | ||||||||
| AuthorizedOfficialFirstName: | DEENA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRIVACY OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5023942387 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | NC | N | Agencies | Case Management | 251C00000X | NC | N | Agencies | Day Training, Developmentally Disabled Services | 251E00000X | NC | N | Agencies | Home Health | 251S00000X | NC | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 8300520H | 05 | NC | MEDICAID | 8300522H | 05 | NC | MEDICAID | 8300526H | 05 | NC | MEDICAID | 8300526B | 05 | NC | MEDICAID | 8300528G | 05 | NC | MEDICAID | 8300498 | 05 | NC | MEDICAID | 8300646G | 05 | NC | MEDICAID | 8300787H | 05 | NC | MEDICAID | 8300498B | 05 | NC | MEDICAID | 8300498G | 05 | NC | MEDICAID | 8300528H | 05 | NC | MEDICAID | 8300646H | 05 | NC | MEDICAID | 8300498H | 05 | NC | MEDICAID | 8300500B | 05 | NC | MEDICAID | 8300523H | 05 | NC | MEDICAID | 8300526G | 05 | NC | MEDICAID | 8300500H | 05 | NC | MEDICAID | 8300534H | 05 | NC | MEDICAID |