NPIMap

Organization Active NPI

Professional Healthcare Resources Inc

  • Community Based Hospice Care Agency
  • Annandale, VA
National Provider Identifier
1346562527
Registry record updated Jun 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
PROFESSIONAL HEALTHCARE RESOURCES INC
Practice address
7619 Little River Tpke
Suite 600
Annandale, VA 22003-2625
Phone
(703) 752-8700
NPI assigned
Feb 16, 2010
Last updated
Jun 25, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brian Clemens
Title
Director of Finance
Phone
(703) 752-8700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

7619 Little River Tpke
Suite 600
Annandale, VA 22003-2625

Mailing address

7619 Little River Tpke
Suite 600
Annandale, VA 22003-2625
Phone (703) 752-8700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100722000705 VA Part A Provider - Hospice 4284541079 Practice locations: Annandale, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346562527. Details of each certification follow.

Hospice certification: CCN 491599

Legal name
PROFESSIONAL HEALTHCARE RESOURCES, INC.
Certification status
Active
Provider type (POS)
Hospice
Participating since
Oct 4, 2010
Last certification
Sep 12, 2013
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Jan 21, 1994 in VA
Enrollment address
7619 Little River Tpke
Ste 600
Annandale, VA 22003-2628

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
Professional Healthcare Resources, IncCCN 491599 · All quality measures
Ownership
For-Profit
Certified
Oct 4, 2010
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Professional Healthcare Resources Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Professional Healthcare Resources, Inc. Organization, Annandale, VA Operational/Managerial Control May 3, 2010
De Cesare GST Non-Grantor Gift Trust Organization, Annandale, VA Created for acquisition 5% Or Greater Indirect Ownership Interest May 3, 2010 52.4%
Professional Healthcare Management, Inc Organization, Annandale, VA Management services company Operational/Managerial Control May 3, 2010
Ronald Decesare Individual 5% Or Greater Indirect Ownership Interest Feb 29, 2008 45%
PHR Holdings, Inc. Organization, Annandale, VA Created for acquisition, Holding company 5% Or Greater Direct Ownership Interest May 3, 2010 100%
Pilar Z Godoy Individual Corporate OfficerTreasurer Jan 21, 1994
Corporate DirectorTreasurer Jan 21, 1994
Eileen Decesare Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2004 2.6%
Corporate OfficerPresident & Board Chair Jan 21, 1994
Corporate DirectorPresident & Board Chair May 3, 2010
Operational/Managerial Control Jan 1, 2019

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 7

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
PHR of Maryland, Inc.Lanham, MD, CCN 217120A Home health agency Operational/Managerial Control May 2, 2003
Professional Healthcare Resources of Washington DC, Inc.Washington, DC, CCN 097049 Home health agency Operational/Managerial Control Apr 21, 2000
Professional Healthcare Resources, Inc.Annandale, VA, CCN 497502 Home health agency Operational/Managerial Control Apr 21, 2000
Professional Healthcare Resources of Maryland IncKensington, MD, CCN 217154 Home health agency Operational/Managerial Control Mar 18, 2002
PHR of Baltimore, Inc.Baltimore, MD, CCN 217036 Home health agency Operational/Managerial Control Apr 21, 2000
PHR of Baltimore, Inc.Baltimore, MD, CCN 211512 Hospice Other Jun 6, 2006
Professional Healthcare Resources of Washington DC, Inc.Washington, DC, CCN 091506 Hospice Operational/Managerial Control
Other		 Sep 18, 2009
Sep 18, 2009

Owned or controlled facilities with NPI records 7

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 7

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1266278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277424000000",
    "number": "1346562527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7619 LITTLE RIVER TPKE",
            "address_2": "SUITE 600",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220032625",
            "telephone_number": "703-752-8700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7619 LITTLE RIVER TPKE",
            "address_2": "SUITE 600",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220032625",
            "telephone_number": "703-752-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL HEALTHCARE RESOURCES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-16",
        "last_updated": "2010-06-25",
        "status": "A",
        "authorized_official_last_name": "CLEMENS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "703-752-8700"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Annandale, VA

Sources for this page

Verify at the official NPI Registry.