Healthcare Provider Details

I. General information

NPI: 1285945469
Provider Name (Legal Business Name): PRECIOUS ONES PERSONAL CARE HOME INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20944 US HWY 84 EAST PRECIOUS ONES PERSONAL CARE HOME INC.
BOSTON GA
31626
US

IV. Provider business mailing address

20944 US HWY 84 EAST PRECIOUS ONES PERSONAL CARE HOME INC.
BOSTON GA
31626
US

V. Phone/Fax

Practice location:
  • Phone: 229-498-5425
  • Fax: 229-263-9820
Mailing address:
  • Phone: 229-498-5425
  • Fax: 229-263-9820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number136-01-097-1
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number136-01-097-1
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number136-01-097-1
License Number StateGA

VIII. Authorized Official

Name: MRS. BOBBIE JEAN RICHARDSON
Title or Position: OWNER-DIRECTOR
Credential:
Phone: 229-498-5425