Provider Demographics
NPI:1093302739
Name:PRECIOUS HEALTH CARE LLC
Entity Type:Organization
Organization Name:PRECIOUS HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:IKE
Authorized Official - Middle Name:M
Authorized Official - Last Name:IFEACHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-404-1294
Mailing Address - Street 1:3626 LONGRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-2555
Mailing Address - Country:US
Mailing Address - Phone:301-404-1294
Mailing Address - Fax:410-569-3789
Practice Address - Street 1:3626 LONGRIDGE CT
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-2555
Practice Address - Country:US
Practice Address - Phone:301-404-1294
Practice Address - Fax:410-569-3789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5282025100Medicaid