Provider Demographics
NPI:1033342449
Name:PRECIOUS LIFE CENTER
Entity Type:Organization
Organization Name:PRECIOUS LIFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AKOSUA
Authorized Official - Middle Name:AMOAFO
Authorized Official - Last Name:AGYAPONGYEBOAH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:513-307-1189
Mailing Address - Street 1:8938 HIALEAH DRIVE
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069
Mailing Address - Country:US
Mailing Address - Phone:513-563-7283
Mailing Address - Fax:
Practice Address - Street 1:2166 N GETTYSBURG AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-3514
Practice Address - Country:US
Practice Address - Phone:937-626-6668
Practice Address - Fax:937-281-0154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1879085251K00000X
OH346535251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1033342449Medicaid
OH3007776Medicaid