Healthcare Provider Details

I. General information

NPI: 1093302739
Provider Name (Legal Business Name): PRECIOUS HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3626 LONGRIDGE CT
ABINGDON MD
21009-2555
US

IV. Provider business mailing address

3626 LONGRIDGE CT
ABINGDON MD
21009-2555
US

V. Phone/Fax

Practice location:
  • Phone: 301-404-1294
  • Fax: 410-569-3789
Mailing address:
  • Phone: 301-404-1294
  • Fax: 410-569-3789

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
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. IKE M IFEACHO
Title or Position: ADMINISTRATOR
Credential:
Phone: 301-404-1294