1891833638 NPI number — PERSONAL HOMECARE INC

Table of content: (NPI 1891833638)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891833638 NPI number — PERSONAL HOMECARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERSONAL HOMECARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
1ST CARE AT HOME
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891833638
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1006
Provider Second Line Business Mailing Address:
425 MAIN STREET
Provider Business Mailing Address City Name:
SOUTH BOSTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24592-1006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-572-1582
Provider Business Mailing Address Fax Number:
434-572-2631

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
860 N MECKLENBURG AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH HILL
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23970-4001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-447-8820
Provider Business Practice Location Address Fax Number:
434-447-8823
Provider Enumeration Date:
02/02/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BURKHOLDER
Authorized Official First Name:
ALFRED
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
434-572-1582

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)