# PROFESSIONAL CARE HOME CARE AGENCY, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083105175
- **Authorized official:** MRS. NELLIE KRIVOSHEYEV (PRESIDENT)
- **Authorized official phone:** (347) 683-5773

## Contact information

- **Practice address:** 2050 CENTER AVE STE 318, FORT LEE, NJ 07024-4932
- **Practice address phone:** (347) 683-5773
- **Practice address fax:** (201) 944-4029
- **Mailing address:** 2050 CENTER AVE STE 318, FORT LEE, NJ 07024-4932
- **Mailing address phone:** (347) 683-5773
- **Mailing address fax:** (201) 944-4029

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | HP0275000 | NJ | Yes |

## Other

- **Enumeration date:** 05/23/2018
- **Last updated:** 05/23/2018