MEDICARE: PRECIOUS LIVING SPRING TEXAS CORPORATION

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	251C00000X	Developmentally Disabled Services Day Training Agency
2	251F00000X	Home Infusion Agency
3	251J00000X	Nursing Care Agency	04447	TX
4	253Z00000X	In Home Supportive Care Agency
5	302F00000X	Exclusive Provider Organization
6	310400000X	Assisted Living Facility		TX
7	251E00000X	Home Health Agency		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508200999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRECIOUS LIVING SPRING TEXAS CORPORATION

Provider Business Mailing Address
First Line	:	1324 LEMM ROAD 2
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-5788
Country	:	US
Telephone Number	:	832-332-7235
Fax Number	:	866-493-4007

Provider Business Practice Location Address
First Line	:	1324 LEMM ROAD 2
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-5788
Country	:	US
Telephone Number	:	832-332-7235
Fax Number	:	866-493-4007

Authorized Official
Title or Position	:	DON
Name	:	PRECIOUS JOHNSON
Credential	:
Telephone Number	:	832-332-7235

Provider Enumeration Date	:	04/29/2013
Last Update Date	:	05/17/2013

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