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General NPI Number Information
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NPI Number | 1215488143
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Entity Type | Organization
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Legal Business Name | PC IN HOME SUPPORT
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Dates
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Enumeration Date | 10/14/2016
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Last Update Date | 10/14/2016
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Provider Practice Location Address
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Address Line | 4030 PASSAGE WAY
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City | LANCASTER
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State | TX
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Zip | 75146-0106
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Country | US
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Telephone | 214-991-5619
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Fax | 469-779-6112
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Provider Business Mailing Address
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Address Line | PO BOX 1114
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City | LANCASTER
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State | TX
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Zip | 75146-8114
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Country | US
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Telephone | 214-991-5619
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Fax | 469-779-6112
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Authorized Official
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Title or Position | OWNER
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Name | MR. ANTOINE MOURY'E BEACHUM
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Credential | CMA
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Telephone | 214-991-5619
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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