Provider Demographics
NPI:1982373049
Name:PERSONAL CARE ASSISTANCE LLC
Entity Type:Organization
Organization Name:PERSONAL CARE ASSISTANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FADIL
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:616-634-1297
Mailing Address - Street 1:1610 COUNTY ROAD B W APT 1
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4019
Mailing Address - Country:US
Mailing Address - Phone:616-634-1297
Mailing Address - Fax:
Practice Address - Street 1:2355 HIGHWAY 36 W # 481
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55113-3902
Practice Address - Country:US
Practice Address - Phone:616-634-1297
Practice Address - Fax:651-393-4373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA759128300Medicaid
MNA820658000Medicaid