Provider Demographics
NPI:1427185206
Name:PCRMC-HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:PCRMC-HEALTH SERVICES, INC.
Other - Org Name:PHELPS HEALTH HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-458-7916
Mailing Address - Street 1:1500 E STATE HWY 72
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-3926
Mailing Address - Country:US
Mailing Address - Phone:573-364-2425
Mailing Address - Fax:573-364-3993
Practice Address - Street 1:1500 E STATE HWY 72
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-3926
Practice Address - Country:US
Practice Address - Phone:573-364-2425
Practice Address - Fax:573-364-3993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0004588163WC1500X, 164W00000X, 374U00000X
376J00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO263815508Medicaid