Provider Demographics
NPI:1851874994
Name:P-CARES MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:P-CARES MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-786-0888
Mailing Address - Street 1:3476 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:MS
Mailing Address - Zip Code:39069-4602
Mailing Address - Country:US
Mailing Address - Phone:601-597-4840
Mailing Address - Fax:
Practice Address - Street 1:3476 RIVER RD
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MS
Practice Address - Zip Code:39069-4602
Practice Address - Country:US
Practice Address - Phone:601-597-4840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONE LOVE INDEPENDENT LIVING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty