Provider Demographics
NPI:1992476600
Name:CLOSE TO HOME PERSONAL CARE LLC
Entity type:Organization
Organization Name:CLOSE TO HOME PERSONAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ELKOMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-529-3382
Mailing Address - Street 1:PO BOX 7265
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7265
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:234 E BANCROFT DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-8839
Practice Address - Country:US
Practice Address - Phone:573-529-3380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty