Provider Demographics
NPI:1235421421
Name:PERSONAL CARE SERVICES MIDSOUTH, LLC
Entity Type:Organization
Organization Name:PERSONAL CARE SERVICES MIDSOUTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:901-313-9238
Mailing Address - Street 1:201 W LIBERTY AVE
Mailing Address - Street 2:STE. 105
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-2500
Mailing Address - Country:US
Mailing Address - Phone:901-313-9238
Mailing Address - Fax:901-313-9236
Practice Address - Street 1:1723 HIGHWAY 51 S STE E
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-3628
Practice Address - Country:US
Practice Address - Phone:901-313-9238
Practice Address - Fax:901-313-9236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-06
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1000000008567253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care