Provider Demographics
NPI:1871615054
Name:PERSONAL CARE SERVICES INC.
Entity type:Organization
Organization Name:PERSONAL CARE SERVICES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLTSCHLAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-430-5628
Mailing Address - Street 1:401 WEST SUMMER STREET
Mailing Address - Street 2:
Mailing Address - City:MONROE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63456-1316
Mailing Address - Country:US
Mailing Address - Phone:217-430-5628
Mailing Address - Fax:
Practice Address - Street 1:3325 GHOST HOLLOW RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-8560
Practice Address - Country:US
Practice Address - Phone:217-430-5628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO852691419Medicaid