MEDICARE: PRECIOUS ANGELS GROUP HOMES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1134565229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRECIOUS ANGELS GROUP HOMES

Provider Business Mailing Address
First Line	:	10919 FONDREN RD APT 2001
Second Line	:	APT 2001
City	:	HOUSTON
State	:	TX
Zip	:	77096-5533
Country	:	US
Telephone Number	:	832-893-3288
Fax Number	:

Provider Business Practice Location Address
First Line	:	3706 DAWSON LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77051-3221
Country	:	US
Telephone Number	:	832-893-3288
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROGRAM MANAGER
Name	:	MISS CRYSTAL RONNET DONYELL MCDANIEL
Credential	:
Telephone Number	:	832-893-3288

Provider Enumeration Date	:	05/15/2013
Last Update Date	:	05/15/2013

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