Provider Demographics
NPI:1821139379
Name:PERSONAL HOMECARE INC
Entity Type:Organization
Organization Name:PERSONAL HOMECARE INC
Other - Org Name:1ST CARE AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BURKHOLDER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:434-572-1582
Mailing Address - Street 1:425 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-1006
Mailing Address - Country:US
Mailing Address - Phone:434-572-1028
Mailing Address - Fax:434-572-2631
Practice Address - Street 1:2808 OLD FOREST ROAD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2338
Practice Address - Country:US
Practice Address - Phone:434-384-2412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2023-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008751498Medicaid