MEDICARE: PERSONEL ELDER CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	385H00000X	Respite Care

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790088334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSONEL ELDER CARE

Provider Business Mailing Address
First Line	:	2353 SOUTH RIDGE CENTER
Second Line	:	HWY1 SOUTH
City	:	GREENVILLE
State	:	MS
Zip	:	38701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2353 HIGHWAY 1 S
Second Line	:	2353 SOUTH RIDGE CENTER
City	:	GREENVILLE
State	:	MS
Zip	:	38701-8337
Country	:	US
Telephone Number	:	662-334-6335
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GWEN HERMAN
Credential	:
Telephone Number	:	662-334-6335

Provider Enumeration Date	:	12/20/2010
Last Update Date	:	12/20/2010

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Directions to “PERSONEL ELDER CARE ” Practice Location

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