Provider Demographics
NPI:1548336712
Name:PERSONAL HEALTHCARE, INC.
Entity type:Organization
Organization Name:PERSONAL HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:RUTHERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-845-0845
Mailing Address - Street 1:211 E SIX FORKS RD
Mailing Address - Street 2:SUITE 122
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7745
Mailing Address - Country:US
Mailing Address - Phone:919-845-0845
Mailing Address - Fax:919-845-0720
Practice Address - Street 1:36 HALES STORE RD
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:NC
Practice Address - Zip Code:27597-5918
Practice Address - Country:US
Practice Address - Phone:919-404-4774
Practice Address - Fax:919-404-4711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC 2498251E00000X
NCHC 3107251E00000X
NCHC 3108251E00000X
NCHC2355251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601140Medicaid
NC3409595Medicaid
NC6601403Medicaid
NC6601404Medicaid
NC6600944Medicaid