Healthcare Provider Details

I. General information

NPI: 1215096045
Provider Name (Legal Business Name): PRECIOUS NURSES HEALTHCARE AGENCY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W UNIVERSITY AVE
URBANA IL
61801-1775
US

IV. Provider business mailing address

104 W UNIVERSITY AVE
URBANA IL
61801-1775
US

V. Phone/Fax

Practice location:
  • Phone: 217-328-0036
  • Fax: 217-328-0765
Mailing address:
  • Phone: 217-328-0036
  • Fax: 217-328-0765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1740675
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number2006-N0867
License Number StateIL

VIII. Authorized Official

Name: MR. LINUS U ANUKWU
Title or Position: PRESIDENT
Credential:
Phone: 217-530-2106