Healthcare Provider Details

I. General information

NPI: 1134898380
Provider Name (Legal Business Name): PRECIOUS MOMENTS HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 E WASHINGTON ST STE 350
ORLANDO FL
32801-2320
US

IV. Provider business mailing address

1691 GRANDEFLORA AVE
CLERMONT FL
34711-6271
US

V. Phone/Fax

Practice location:
  • Phone: 407-412-5310
  • Fax:
Mailing address:
  • Phone: 407-738-7141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: PATRICE POWELL-GACHAU
Title or Position: OWNER
Credential:
Phone: 407-738-7141