Provider Demographics
NPI:1043344914
Name:PROFESSIONAL CARE SERVICES, INC.
Entity Type:Organization
Organization Name:PROFESSIONAL CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ESQUILIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-977-3353
Mailing Address - Street 1:PO BOX 26150
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314
Mailing Address - Country:US
Mailing Address - Phone:910-977-3353
Mailing Address - Fax:910-867-5175
Practice Address - Street 1:517 SOUTHWICK DR.
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303
Practice Address - Country:US
Practice Address - Phone:910-977-3353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408213Medicaid