Healthcare Provider Details

I. General information

NPI: 1740052877
Provider Name (Legal Business Name): PRECIOUS HEARTS ADULT CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 WILDER CLIFF STREET 104 RALEIGH, N.C.
RALEIGH NC
27615
US

IV. Provider business mailing address

2301 WILDER CLIFF STREET 104 RALEIGH, N.C.
RALEIGH NC
27615
US

V. Phone/Fax

Practice location:
  • Phone: 919-397-8924
  • Fax:
Mailing address:
  • Phone: 919-397-8924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LISA G HOLT
Title or Position: OWNER
Credential:
Phone: 919-397-8924