Provider Demographics
NPI:1174295489
Name:PERSONAL CONTROL AND WELLNESS CONSULTING GROUP LLC
Entity Type:Organization
Organization Name:PERSONAL CONTROL AND WELLNESS CONSULTING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLA ANGELIQUE
Authorized Official - Middle Name:D
Authorized Official - Last Name:CAUSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-479-7173
Mailing Address - Street 1:6030 E STATE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-7639
Mailing Address - Country:US
Mailing Address - Phone:260-452-0554
Mailing Address - Fax:
Practice Address - Street 1:6030 E STATE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-7639
Practice Address - Country:US
Practice Address - Phone:260-452-0554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare
No251V00000XAgenciesVoluntary or Charitable
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care