Provider Demographics
NPI:1467651588
Name:PEGUES PERSONAL CARE AGENCY, INC.
Entity Type:Organization
Organization Name:PEGUES PERSONAL CARE AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:PEGUES
Authorized Official - Suffix:
Authorized Official - Credentials:CRT, RCP
Authorized Official - Phone:1910-318-9996
Mailing Address - Street 1:12180 OAK CROFT TRL
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-1837
Mailing Address - Country:US
Mailing Address - Phone:910-277-1399
Mailing Address - Fax:
Practice Address - Street 1:12180 OAK CROFT TRL
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-1837
Practice Address - Country:US
Practice Address - Phone:910-277-1399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3243251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601418Medicaid