Provider Demographics
NPI:1396224846
Name:MCDOLE PERSONAL CARE LLC
Entity Type:Organization
Organization Name:MCDOLE PERSONAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-230-0341
Mailing Address - Street 1:4500 COLLEY AVE STE J
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23508-2031
Mailing Address - Country:US
Mailing Address - Phone:757-230-0341
Mailing Address - Fax:757-257-0321
Practice Address - Street 1:4500 COLLEY AVE STE J
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23508-2031
Practice Address - Country:US
Practice Address - Phone:757-230-0341
Practice Address - Fax:757-257-0321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care