Healthcare Provider Details

I. General information

NPI: 1679397814
Provider Name (Legal Business Name): PRECIOUS JEWELS BIRTHING PROJECT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 PENISTER ST
WARREN AR
71671-1929
US

IV. Provider business mailing address

1110 PENISTER ST
WARREN AR
71671-1929
US

V. Phone/Fax

Practice location:
  • Phone: 870-466-2546
  • Fax:
Mailing address:
  • Phone: 870-466-2546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name: HAJIME OLIVIA WHITE
Title or Position: DIRECTOR
Credential: DOULA
Phone: 870-466-2546