Provider Demographics
NPI:1356961718
Name:MY PCA GREENVILLES HOME CARE LLC
Entity type:Organization
Organization Name:MY PCA GREENVILLES HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/GOVERNING BODY
Authorized Official - Prefix:MISS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-558-8683
Mailing Address - Street 1:1206 EVANS ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-4102
Mailing Address - Country:US
Mailing Address - Phone:252-558-8683
Mailing Address - Fax:252-862-2987
Practice Address - Street 1:1206 EVANS ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4102
Practice Address - Country:US
Practice Address - Phone:252-558-8683
Practice Address - Fax:252-862-2987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-25
Last Update Date:2020-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health