Provider Demographics
NPI:1053675975
Name:PERSONAL CARE SERVICES OF THE CAROLINAS
Entity Type:Organization
Organization Name:PERSONAL CARE SERVICES OF THE CAROLINAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LAVONNE
Authorized Official - Last Name:WALKER-HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-605-8219
Mailing Address - Street 1:800 W HILL ST STE 207
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-5361
Mailing Address - Country:US
Mailing Address - Phone:704-605-8219
Mailing Address - Fax:
Practice Address - Street 1:800 W HILL ST
Practice Address - Street 2:SUITE 207
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-5360
Practice Address - Country:US
Practice Address - Phone:704-605-8219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4550253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC120285OtherFACILITY ID
NCHC4550OtherLICENSE NUMBER