Provider Demographics
NPI:1538312640
Name:PERSONAL HOME CARE
Entity Type:Organization
Organization Name:PERSONAL HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:DESIREE
Authorized Official - Last Name:FOLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-371-1495
Mailing Address - Street 1:PO BOX 4246
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-8246
Mailing Address - Country:US
Mailing Address - Phone:503-371-1495
Mailing Address - Fax:503-371-1612
Practice Address - Street 1:2659 COMMERCIAL ST SE
Practice Address - Street 2:SUITE 290
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4445
Practice Address - Country:US
Practice Address - Phone:503-371-1495
Practice Address - Fax:503-371-1612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-2020253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care