Provider Demographics
NPI:1528326055
Name:TOTAL CARE PERSONAL CARE HOME LLC
Entity type:Organization
Organization Name:TOTAL CARE PERSONAL CARE HOME LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:REAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-628-4054
Mailing Address - Street 1:PO BOX 703
Mailing Address - Street 2:126 SHINHOLSTER
Mailing Address - City:GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:31031-0703
Mailing Address - Country:US
Mailing Address - Phone:478-628-4054
Mailing Address - Fax:
Practice Address - Street 1:322 MILLEDGEVILLE HWY
Practice Address - Street 2:
Practice Address - City:GORDON
Practice Address - State:GA
Practice Address - Zip Code:31031-4177
Practice Address - Country:US
Practice Address - Phone:478-628-4054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health