Provider Demographics
NPI:1326480179
Name:KHC PCS SERVICES
Entity Type:Organization
Organization Name:KHC PCS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TAJUANA
Authorized Official - Middle Name:GREENARD
Authorized Official - Last Name:KESLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-232-4554
Mailing Address - Street 1:1008 S MAIN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-6456
Mailing Address - Country:US
Mailing Address - Phone:704-232-4554
Mailing Address - Fax:
Practice Address - Street 1:1008 S MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-6456
Practice Address - Country:US
Practice Address - Phone:704-232-4554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KESLER HOME CARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4534251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6602373Medicaid