Provider Demographics
NPI:1841350881
Name:PRIVATE CARE RESOURCES, INC
Entity type:Organization
Organization Name:PRIVATE CARE RESOURCES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHONA
Authorized Official - Middle Name:C
Authorized Official - Last Name:EAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-693-2273
Mailing Address - Street 1:69 E BEAU ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4711
Mailing Address - Country:US
Mailing Address - Phone:724-223-5115
Mailing Address - Fax:724-223-5119
Practice Address - Street 1:5414 6TH AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-1203
Practice Address - Country:US
Practice Address - Phone:814-693-2273
Practice Address - Fax:814-693-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN188041L163WG0000X, 163WG0600X, 163WP0200X, 163WP0809X
PA02200501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
No163WG0600XNursing Service ProvidersRegistered NurseGerontologyGroup - Multi-Specialty
No163WP0200XNursing Service ProvidersRegistered NursePediatricsGroup - Multi-Specialty
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001830071Medicaid