Basic Information
| Provider Information | |||||||||
| NPI: | 1891080297 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIANS HOMECARE SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 390 MAIN ST | ||||||||
| Address2: | SUITE 509 | ||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016082583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087353280 | ||||||||
| FaxNumber: | 5087531974 | ||||||||
| Practice Location | |||||||||
| Address1: | 390 MAIN ST | ||||||||
| Address2: | SUITE 509 | ||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016082583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087353280 | ||||||||
| FaxNumber: | 5087531974 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2011 | ||||||||
| LastUpdateDate: | 06/14/2011 | ||||||||
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| AuthorizedOfficialLastName: | FAJANA | ||||||||
| AuthorizedOfficialFirstName: | KUNLE | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5087353280 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
No ID Information.