Healthcare Provider Details

I. General information

NPI: 1023298379
Provider Name (Legal Business Name): PRECIOUS HOME SERVICE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2007
Last Update Date: 11/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5511 102ND AVE N
BROOKLYN PARK MN
55443-2074
US

IV. Provider business mailing address

5511 102ND AVE N
BROOKLYN PARK MN
55443-2074
US

V. Phone/Fax

Practice location:
  • Phone: 736-425-2830
  • Fax:
Mailing address:
  • Phone: 763-435-2830
  • Fax: 763-425-2830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number334863
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number334862
License Number StateMN

VIII. Authorized Official

Name: MR. NOSA OGIE
Title or Position: PRESIDENT/CEO
Credential:
Phone: 763-425-2830