Provider Demographics
NPI:1396899829
Name:HCC PERSONAL CARE INC
Entity type:Organization
Organization Name:HCC PERSONAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:W
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:NELMS
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:804-378-7780
Mailing Address - Street 1:1519 HUGUENOT RD STE 104
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113
Mailing Address - Country:US
Mailing Address - Phone:804-378-7780
Mailing Address - Fax:804-378-2677
Practice Address - Street 1:1519 HUGUENOT RD STE 104
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113
Practice Address - Country:US
Practice Address - Phone:804-378-7780
Practice Address - Fax:804-378-2677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA008702659251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009102566Medicaid
VA010004217Medicaid