Provider Demographics
NPI:1770180150
Name:NORTH CAROLINA PERSONAL CARE SERVICES LLC
Entity Type:Organization
Organization Name:NORTH CAROLINA PERSONAL CARE SERVICES LLC
Other - Org Name:NORTH CAROLINA PERSONAL CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AGENCY DIRECTOR AND OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHIVA
Authorized Official - Middle Name:LEDAWN
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:336-858-9944
Mailing Address - Street 1:411 PARKWAY ST STE D
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1644
Mailing Address - Country:US
Mailing Address - Phone:336-604-0770
Mailing Address - Fax:336-604-0752
Practice Address - Street 1:411 PARKWAY ST STE D
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1644
Practice Address - Country:US
Practice Address - Phone:336-604-0770
Practice Address - Fax:336-604-0752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1770180150Medicaid