MEDICARE: PERSONAL CONTROL AND WELLNESS CONSULTING GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251C00000X	Developmentally Disabled Services Day Training Agency
3	251E00000X	Home Health Agency
4	251K00000X	Public Health or Welfare Agency
5	251V00000X	Voluntary or Charitable Agency
6	252Y00000X	Early Intervention Provider Agency
7	253Z00000X	In Home Supportive Care Agency
8	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1174295489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSONAL CONTROL AND WELLNESS CONSULTING GROUP LLC

Provider Business Mailing Address
First Line	:	6030 E STATE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-7639
Country	:	US
Telephone Number	:	260-452-0554
Fax Number	:

Provider Business Practice Location Address
First Line	:	6030 E STATE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-7639
Country	:	US
Telephone Number	:	260-452-0554
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. ELLA ANGELIQUE D CAUSEY
Credential	:
Telephone Number	:	260-479-7173

Provider Enumeration Date	:	10/05/2021
Last Update Date	:	10/05/2021

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