=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316863632
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PK HOMECARE SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2026
-----------------------------------------------------
Last Update Date | 06/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3511 SHANNON RD STE 346
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27707-6330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-482-1228
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 902 PEBBLESTONE DR
-----------------------------------------------------
City | DURHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27703-7193
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-482-1228
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | PANDWE A KALALA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-482-1228
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------