Provider Demographics
NPI:1578603734
Name:PRECIOUS PEARL GROUP HOME, INC.
Entity Type:Organization
Organization Name:PRECIOUS PEARL GROUP HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIR.
Authorized Official - Prefix:MS
Authorized Official - First Name:DELPHINA
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:B S DEGREE
Authorized Official - Phone:336-691-1609
Mailing Address - Street 1:1000 ELWELL AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-6112
Mailing Address - Country:US
Mailing Address - Phone:336-691-1609
Mailing Address - Fax:
Practice Address - Street 1:1000 ELWELL AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6112
Practice Address - Country:US
Practice Address - Phone:336-691-1609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-698311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408821Medicaid
NC7803329Medicaid
NC8300228Medicaid