Provider Demographics
NPI:1639596869
Name:PRECIOUS MEDICAL HEALTH SER LLC
Entity Type:Organization
Organization Name:PRECIOUS MEDICAL HEALTH SER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:YOLONDA
Authorized Official - Middle Name:P
Authorized Official - Last Name:HENDKING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-289-7647
Mailing Address - Street 1:25000 EUCLID AVE #408
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117
Mailing Address - Country:US
Mailing Address - Phone:216-289-7647
Mailing Address - Fax:877-262-2161
Practice Address - Street 1:25000 EUCLID AVE #408
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117
Practice Address - Country:US
Practice Address - Phone:216-289-7647
Practice Address - Fax:877-262-2161
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRECIOUS MEDICAL HEALTH SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0066765Medicaid