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General NPI Number Information
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NPI Number | 1437714953
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Entity Type | Organization
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Legal Business Name | PRECIOUS HOSPICE OF CHICAGO, LLC
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Dates
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Enumeration Date | 05/09/2019
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Last Update Date | 05/09/2019
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Provider Practice Location Address
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Address Line | 3517 S KING DR
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City | CHICAGO
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State | IL
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Zip | 60653-1109
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Country | US
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Telephone | 470-878-5051
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Fax |
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Provider Business Mailing Address
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Address Line | 105 HABERSHAM DR STE D
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7341
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Country | US
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Telephone | 470-878-5051
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | HENRY MASON
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Credential |
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Telephone | 470-878-5051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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