Healthcare Provider Details

I. General information

NPI: 1356922041
Provider Name (Legal Business Name): PRECIOUS CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 SUNNY SLOPE RD
BRIDGEWATER NJ
08807-3607
US

IV. Provider business mailing address

2007 SUNNY SLOPE RD
BRIDGEWATER NJ
08807-3607
US

V. Phone/Fax

Practice location:
  • Phone: 862-324-1402
  • Fax: 908-393-1788
Mailing address:
  • Phone: 862-324-1402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAUS G KOMLA-AZA
Title or Position: PRESIDENT
Credential:
Phone: 862-324-1402