Professional Care Nursing Agency LLC

Primary specialty

Home Health AideTaxonomy code 374U00000X

Legal business name

PROFESSIONAL CARE NURSING AGENCY LLC

Practice address

1670 McKendree Church Rd Ste B
Lawrenceville, GA 30043-4107

Phone

(678) 462-1185

Fax

(678) 269-4002

NPI assigned

Aug 23, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Cheryl Nicola Mascoe, CEO

Title

Ceo

Phone

(678) 462-1185

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733875200000",
    "number": "1740956309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1670 MCKENDREE CHURCH RD STE 50",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300436676",
            "telephone_number": "678-462-1185",
            "fax_number": "678-269-4002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1670 MCKENDREE CHURCH RD STE B",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300434107",
            "telephone_number": "678-462-1185",
            "fax_number": "678-269-4002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL CARE NURSING AGENCY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-23",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A",
        "authorized_official_last_name": "MASCOE",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "NICOLA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-462-1185",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "374U00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Home Health Aide",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "376K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse's Aide",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Home Health Aide in Lawrenceville, GA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.