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General NPI Number Information
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NPI Number | 1174295489
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Entity Type | Organization
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Legal Business Name | PERSONAL CONTROL AND WELLNESS CONSULTING GROUP LLC
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 10/05/2021
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Provider Practice Location Address
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Address Line | 6030 E STATE BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46815-7639
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Country | US
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Telephone | 260-452-0554
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Fax |
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Provider Business Mailing Address
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Address Line | 6030 E STATE BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46815-7639
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Country | US
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Telephone | 260-452-0554
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. ELLA ANGELIQUE D CAUSEY
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Credential |
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Telephone | 260-479-7173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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