MEDICARE: PRECIOUS WORCS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251X00000X	Supports Brokerage Agency
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1912432808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRECIOUS WORCS INC

Provider Business Mailing Address
First Line	:	PO BOX 350717
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11435-0717
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25307 MEMPHIS AVE
Second Line	:
City	:	ROSEDALE
State	:	NY
Zip	:	11422-2527
Country	:	US
Telephone Number	:	917-309-0119
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. TISHA N UMEADI
Credential	:
Telephone Number	:	917-309-0119

Provider Enumeration Date	:	04/27/2017
Last Update Date	:	04/27/2017

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Directions to “PRECIOUS WORCS INC ” Practice Location

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