Provider Demographics
NPI:1063805166
Name:PERSONAL HOMECARE, INC.
Entity type:Organization
Organization Name:PERSONAL HOMECARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BURKHOLDER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:434-572-1582
Mailing Address - Street 1:PO BOX 1006
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-1006
Mailing Address - Country:US
Mailing Address - Phone:434-572-1028
Mailing Address - Fax:
Practice Address - Street 1:425 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-3241
Practice Address - Country:US
Practice Address - Phone:434-572-1028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-13
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333300000X, 251B00000X, 385H00000X, 385HR2060X, 385HR2065X, 385HR2055X, 146D00000X
VA8702594253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No333300000XSuppliersEmergency Response System Companies
No251B00000XAgenciesCase Management
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8751111Medicaid
VA9106235Medicaid
VA9106251Medicaid
VA8702411Medicaid
VA9119868Medicaid
VA8771677Medicaid
VA8702594Medicaid
VA8704368Medicaid
VA8771693Medicaid
VA8773289Medicaid
VA8751013Medicaid
VA8751498Medicaid