=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871615054
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PERSONAL CARE SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2007
-----------------------------------------------------
Last Update Date | 03/24/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3325 GHOST HOLLOW RD
-----------------------------------------------------
City | QUINCY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62305-8560
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-430-5628
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 WEST SUMMER STREET
-----------------------------------------------------
City | MONROE CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63456-1316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-430-5628
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. PAUL J HOLTSCHLAG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 217-430-5628
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------