=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205996139
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHILSON,S PERSONAL CARE ASSOCIATES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 S MCLEWEAN ST
-----------------------------------------------------
City | KINSTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28501-4921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-520-9353
-----------------------------------------------------
Fax | 252-526-0131
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3023
-----------------------------------------------------
City | KINSTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28502-3023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-520-9353
-----------------------------------------------------
Fax | 252-526-0131
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | BEVERLY J PHILSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 252-520-9353
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HC1773
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------