Provider Demographics
NPI:1134691314
Name:P CARES MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:P CARES MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-786-0888
Mailing Address - Street 1:3476 RIVER RD STE A
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:MS
Mailing Address - Zip Code:39069-4602
Mailing Address - Country:US
Mailing Address - Phone:601-597-4840
Mailing Address - Fax:
Practice Address - Street 1:3476 RIVER RD STE A
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MS
Practice Address - Zip Code:39069-4602
Practice Address - Country:US
Practice Address - Phone:601-597-4840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:P-CARES PRIVATE DUTY NURSING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing Care
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty