Provider Demographics
NPI:1568852176
Name:PRECIOUS MOMENTS HOME CARE SERVICES, LLC
Entity Type:Organization
Organization Name:PRECIOUS MOMENTS HOME CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:CORTRELE
Authorized Official - Last Name:HAWTHORNE
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:443-977-1353
Mailing Address - Street 1:818 KINGSTON CT
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-2103
Mailing Address - Country:US
Mailing Address - Phone:443-977-1353
Mailing Address - Fax:
Practice Address - Street 1:336 S MAIN ST
Practice Address - Street 2:SUITE 2E-B
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3978
Practice Address - Country:US
Practice Address - Phone:443-977-1353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3733P251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care