Provider Demographics
NPI:1619247533
Name:A PERSONALIZED HOME CARE AGENCY
Entity Type:Organization
Organization Name:A PERSONALIZED HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:TIMELISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-682-8277
Mailing Address - Street 1:925 S KERR AVE
Mailing Address - Street 2:SUITE L
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4335
Mailing Address - Country:US
Mailing Address - Phone:910-742-3198
Mailing Address - Fax:
Practice Address - Street 1:925 S KERR AVE
Practice Address - Street 2:SUITE L
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4335
Practice Address - Country:US
Practice Address - Phone:910-742-3198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4504253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care