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General NPI Number Information
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NPI Number | 1053845875
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Entity Type | Organization
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Legal Business Name | PRECIOUS LIFE CARE PRIVATE DUTY
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 04/18/2017
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Provider Practice Location Address
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Address Line | 1104 BARTOW RD
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City | LAKELAND
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State | FL
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Zip | 33801-5850
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Country | US
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Telephone | 863-812-9570
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 24874
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City | LAKELAND
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State | FL
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Zip | 33802-4874
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CERTIFED NURSE ASSISTANT/OWNER
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Name | BRITTANY BROWN
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Credential |
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Telephone | 863-812-9570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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