Provider Demographics
NPI:1154487213
Name:PERSONAL CARE COMMUNITY SERVICES
Entity Type:Organization
Organization Name:PERSONAL CARE COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWINA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-286-0547
Mailing Address - Street 1:PO BOX 72267
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27722-2267
Mailing Address - Country:US
Mailing Address - Phone:919-286-0547
Mailing Address - Fax:919-286-0547
Practice Address - Street 1:2922 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3915
Practice Address - Country:US
Practice Address - Phone:919-286-0547
Practice Address - Fax:919-286-0547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-30
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3604251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health