Provider Demographics
NPI:1962413997
Name:PLC PROFESSIONAL STAFFING SOLUTIONS, LLC
Entity type:Organization
Organization Name:PLC PROFESSIONAL STAFFING SOLUTIONS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PANDORA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDMOND
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:662-335-5554
Mailing Address - Street 1:PO BOX 4580
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38704-4580
Mailing Address - Country:US
Mailing Address - Phone:662-335-5554
Mailing Address - Fax:662-335-5554
Practice Address - Street 1:306 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-3614
Practice Address - Country:US
Practice Address - Phone:662-335-5554
Practice Address - Fax:662-335-5580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR863014251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08679792Medicaid
MS06908787Medicaid
MS07331397Medicaid