Provider Demographics
NPI:1225159247
Name:PRECIOUS CARE HOME HEALTH INC
Entity Type:Organization
Organization Name:PRECIOUS CARE HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:NIBA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:972-680-0096
Mailing Address - Street 1:811 S CENTRAL EXPY STE 304
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-7424
Mailing Address - Country:US
Mailing Address - Phone:972-680-0096
Mailing Address - Fax:972-680-8318
Practice Address - Street 1:811 S CENTRAL EXPY STE 304
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-7424
Practice Address - Country:US
Practice Address - Phone:972-680-0096
Practice Address - Fax:972-680-8318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2023-02-17
Deactivation Date:2008-01-22
Deactivation Code:
Reactivation Date:2008-01-30
Provider Licenses
StateLicense IDTaxonomies
TX005944251E00000X
251J00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001001012Medicaid
TX001002202Medicaid
TX24916101Medicaid
TX001001011Medicaid