Provider Demographics
NPI:1982804324
Name:PRC ENTERPRISES, INC.
Entity Type:Organization
Organization Name:PRC ENTERPRISES, INC.
Other - Org Name:MY HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-778-1126
Mailing Address - Street 1:650 VINE ST
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-5039
Mailing Address - Country:US
Mailing Address - Phone:573-778-1126
Mailing Address - Fax:573-785-4887
Practice Address - Street 1:650 VINE ST
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-5039
Practice Address - Country:US
Practice Address - Phone:573-778-1126
Practice Address - Fax:573-785-4887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities