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General NPI Number Information
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NPI Number | 1811214992
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Entity Type | Organization
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Legal Business Name | PRECIOUS PROFESSIONAL
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Dates
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Enumeration Date | 04/28/2010
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Last Update Date | 04/28/2010
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Provider Practice Location Address
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Address Line | 1502 GODWIN AVE
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City | LUMBERTON
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State | NC
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Zip | 28358-4206
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Country | US
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Telephone | 910-738-3211
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Fax | 910-738-3234
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Provider Business Mailing Address
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Address Line | 1202 CARTHAGE RD
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City | LUMBERTON
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State | NC
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Zip | 28358-3406
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Country | US
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Telephone | 910-738-3211
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Fax | 910-738-3234
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Authorized Official
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Title or Position | CEO
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Name | IRENE THOMPSON GRAHAM
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Credential | RN,BC
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Telephone | 910-738-3211
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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 | 087054
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License Number State | NC
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