Healthcare Provider Details

I. General information

NPI: 1851874994
Provider Name (Legal Business Name): P-CARES MEDICAL SUPPLIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3476 RIVER RD
FAYETTE MS
39069-4602
US

IV. Provider business mailing address

3476 RIVER RD
FAYETTE MS
39069-4602
US

V. Phone/Fax

Practice location:
  • Phone: 601-597-4840
  • Fax:
Mailing address:
  • Phone: 601-597-4840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: MR. ALFORD PERRYMAN
Title or Position: CEO / DIRECTOR
Credential:
Phone: 601-786-0888