Provider Demographics
NPI:1649574963
Name:ALSTON PERSONAL CARE SERVICES
Entity Type:Organization
Organization Name:ALSTON PERSONAL CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMIKA
Authorized Official - Middle Name:TERRELL
Authorized Official - Last Name:ALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-375-8050
Mailing Address - Street 1:1903 BRIGHTWOOD LANDING LN
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-1831
Mailing Address - Country:US
Mailing Address - Phone:336-375-8050
Mailing Address - Fax:336-621-3342
Practice Address - Street 1:1903 BRIGHTWOOD LANDING LN
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-1831
Practice Address - Country:US
Practice Address - Phone:336-375-8050
Practice Address - Fax:336-621-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601416Medicaid