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General NPI Number Information
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NPI Number | 1982057204
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Entity Type | Organization
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Legal Business Name | PRECIOUSCARE GROUP HOMES INC
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Dates
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Enumeration Date | 07/21/2016
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Last Update Date | 07/21/2016
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Provider Practice Location Address
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Address Line | 18121 E 8 MILE RD SUITE 219
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City | EASTPOINTE
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State | MI
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Zip | 48021-3245
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Country | US
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Telephone | 313-465-9199
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Fax |
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Provider Business Mailing Address
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Address Line | 21175 SAVANNAH DR
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48036-1474
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Country | US
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Telephone | 313-465-9199
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SANDRA OBAKPOLOR
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Credential |
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Telephone | 313-465-9199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | AS820289004
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License Number State | MI
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