Healthcare Provider Details

I. General information

NPI: 1417235771
Provider Name (Legal Business Name): PCA PLUS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419-A COLLEGE DR. SUITE 6
MIDDLEBURG FL
32068
US

IV. Provider business mailing address

419-A COLLEGE DR. SUITE 6
MIDDLEBURG FL
32068
US

V. Phone/Fax

Practice location:
  • Phone: 904-272-5096
  • Fax: 904-272-5097
Mailing address:
  • Phone: 904-272-5096
  • Fax: 904-272-5097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MARY A. SMITH
Title or Position: OWNER
Credential:
Phone: 904-272-5096