Provider Demographics
NPI:1083350391
Name:PRECIOUS SAPPHIRES HEALTHCARE INC
Entity Type:Organization
Organization Name:PRECIOUS SAPPHIRES HEALTHCARE INC
Other - Org Name:PRECIOUS SAPPHIRES HEALTHCARE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ADEPEMI
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIYANBOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-824-0495
Mailing Address - Street 1:200 CONTINENTAL DR STE 401
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-4337
Mailing Address - Country:US
Mailing Address - Phone:443-824-0495
Mailing Address - Fax:
Practice Address - Street 1:200 CONTINENTAL DR STE 401
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4337
Practice Address - Country:US
Practice Address - Phone:443-824-0495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-10
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities