=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730578980
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRECIOUS CARE AT HOME SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2015
-----------------------------------------------------
Last Update Date | 01/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1735 MARKET ST SUITE 3750
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19103-7501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-507-6156
-----------------------------------------------------
Fax | 267-507-6150
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1735 MARKET ST SUITE 3750
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19103-7501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-507-6156
-----------------------------------------------------
Fax | 267-507-6150
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. NAILEY COLE
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 703-425-2273
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 05520501
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------