Provider Demographics
NPI:1740956309
Name:PROFESSIONAL CARE NURSING AGENCY LLC
Entity type:Organization
Organization Name:PROFESSIONAL CARE NURSING AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:NICOLA
Authorized Official - Last Name:MASCOE
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:678-462-1185
Mailing Address - Street 1:1670 MCKENDREE CHURCH RD STE 50
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-6676
Mailing Address - Country:US
Mailing Address - Phone:678-462-1185
Mailing Address - Fax:678-269-4002
Practice Address - Street 1:1670 MCKENDREE CHURCH RD STE B
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-4107
Practice Address - Country:US
Practice Address - Phone:678-462-1185
Practice Address - Fax:678-269-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty