1063805166 NPI number — PERSONAL HOMECARE, INC.

Table of content: (NPI 1063805166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063805166 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:
1063805166
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2023
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:
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:
434-572-1028
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
425 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH BOSTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24592-3241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-572-1028
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/13/2015

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 146D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: 8702594 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 333300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385HR2055X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385HR2060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385HR2065X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 8751111 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9106235 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9106251 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8702411 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9119868 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8771677 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8702594 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8704368 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8771693 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8773289 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8751013 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8751498 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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