Provider Demographics
NPI:1336285329
Name:PRECIOUS CARE HOME CARE AGENCY
Entity Type:Organization
Organization Name:PRECIOUS CARE HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ROYSTER
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-693-7017
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:STOVALL
Mailing Address - State:NC
Mailing Address - Zip Code:27582-0040
Mailing Address - Country:US
Mailing Address - Phone:919-693-7017
Mailing Address - Fax:919-693-1318
Practice Address - Street 1:111 ELM ST.
Practice Address - Street 2:
Practice Address - City:STOVALL
Practice Address - State:NC
Practice Address - Zip Code:27582-0040
Practice Address - Country:US
Practice Address - Phone:919-693-7017
Practice Address - Fax:919-693-1318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3612251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601614Medicaid