Healthcare Provider Details

I. General information

NPI: 1720924871
Provider Name (Legal Business Name): PRECIOUS MOMENTS COMMUNITY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 OXFORD ST
FORT WAYNE IN
46806-4383
US

IV. Provider business mailing address

3105 OXFORD ST
FORT WAYNE IN
46806-4383
US

V. Phone/Fax

Practice location:
  • Phone: 419-230-5115
  • Fax:
Mailing address:
  • Phone: 419-230-5115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LASHONDA ACKLES
Title or Position: OWNER
Credential: RN
Phone: 419-230-5115