Healthcare Provider Details

I. General information

NPI: 1831913508
Provider Name (Legal Business Name): PRECIOUS LIFE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 11/30/2024
Certification Date: 11/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 BISON TRL
WAUKEE IA
50263-1206
US

IV. Provider business mailing address

3915 BISON TRL
WAUKEE IA
50263-1206
US

V. Phone/Fax

Practice location:
  • Phone: 602-544-9239
  • Fax:
Mailing address:
  • Phone: 602-544-9239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral 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: MS. MAYSOON DENG
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 602-544-9239