Provider Demographics
NPI:1215488143
Name:PC IN HOME SUPPORT
Entity type:Organization
Organization Name:PC IN HOME SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTOINE
Authorized Official - Middle Name:MOURY'E
Authorized Official - Last Name:BEACHUM
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:214-991-5619
Mailing Address - Street 1:PO BOX 1114
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-8114
Mailing Address - Country:US
Mailing Address - Phone:214-991-5619
Mailing Address - Fax:469-779-6112
Practice Address - Street 1:4030 PASSAGE WAY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-0106
Practice Address - Country:US
Practice Address - Phone:214-991-5619
Practice Address - Fax:469-779-6112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health