Provider Demographics
NPI:1669511069
Name:PRECIOUS LIFE HOME HEALTH, INC
Entity Type:Organization
Organization Name:PRECIOUS LIFE HOME HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:956-369-8994
Mailing Address - Street 1:1701 QUAMASIA AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-9567
Mailing Address - Country:US
Mailing Address - Phone:956-683-8050
Mailing Address - Fax:866-309-3196
Practice Address - Street 1:1701 QUAMASIA AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-9567
Practice Address - Country:US
Practice Address - Phone:956-683-8050
Practice Address - Fax:866-309-3196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011039251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747189Medicare PIN