MEDICARE: PRECIOUS MOMENTS COMMUNITY CARE, LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1720924871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRECIOUS MOMENTS COMMUNITY CARE, LLC

Provider Business Mailing Address
First Line	:	3105 OXFORD ST
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-4383
Country	:	US
Telephone Number	:	419-230-5115
Fax Number	:

Provider Business Practice Location Address
First Line	:	3105 OXFORD ST
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46806-4383
Country	:	US
Telephone Number	:	419-230-5115
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LASHONDA ACKLES
Credential	:	RN
Telephone Number	:	419-230-5115

Provider Enumeration Date	:	04/28/2026
Last Update Date	:	05/04/2026

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