Healthcare Provider Details

I. General information

NPI: 1467111054
Provider Name (Legal Business Name): PLATINUM CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2021
Last Update Date: 12/11/2021
Certification Date: 12/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 THRUSH ST
PRINCE GEORGE VA
23875-3452
US

IV. Provider business mailing address

181 THRUSH ST
PRINCE GEORGE VA
23875-3452
US

V. Phone/Fax

Practice location:
  • Phone: 434-603-1646
  • Fax:
Mailing address:
  • Phone: 434-603-1646
  • 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 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

VIII. Authorized Official

Name: SHELBY HARRIS
Title or Position: OWNER
Credential:
Phone: 434-603-1646