Provider Demographics
NPI:1023739711
Name:PROFESSIONAL SERVICES OF HOLY CROSS
Entity type:Organization
Organization Name:PROFESSIONAL SERVICES OF HOLY CROSS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-754-7035
Mailing Address - Street 1:PO BOX 531863
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-1863
Mailing Address - Country:US
Mailing Address - Phone:301-754-7201
Mailing Address - Fax:
Practice Address - Street 1:10605 CONCORD ST
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2504
Practice Address - Country:US
Practice Address - Phone:301-949-4242
Practice Address - Fax:301-557-1916
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLY CROSS HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service