Provider Demographics
NPI:1023363686
Name:REBECCA'S PERSONAL CARE HOME INC
Entity Type:Organization
Organization Name:REBECCA'S PERSONAL CARE HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:COREY
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-652-2834
Mailing Address - Street 1:118 MASTERS AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-1216
Mailing Address - Country:US
Mailing Address - Phone:814-652-2834
Mailing Address - Fax:814-652-5090
Practice Address - Street 1:118 MASTERS AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-1216
Practice Address - Country:US
Practice Address - Phone:814-652-2834
Practice Address - Fax:814-652-5090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA324070311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home