Provider Demographics
NPI:1649606849
Name:PERSONAL HOME CARE
Entity type:Organization
Organization Name:PERSONAL HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:503-949-3914
Mailing Address - Street 1:1320 LEWIS ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2526
Mailing Address - Country:US
Mailing Address - Phone:503-371-1495
Mailing Address - Fax:503-371-1612
Practice Address - Street 1:1320 LEWIS ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2526
Practice Address - Country:US
Practice Address - Phone:503-371-1495
Practice Address - Fax:503-371-1612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15-2020251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health