Provider Demographics
NPI:1710263355
Name:PERSONALIZED NURSING SERVICES
Entity Type:Organization
Organization Name:PERSONALIZED NURSING SERVICES
Other - Org Name:PRECIOUS LIVES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:CRYSTAL
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:313-282-1961
Mailing Address - Street 1:26520 GRAND RIVER AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-1506
Mailing Address - Country:US
Mailing Address - Phone:313-282-1961
Mailing Address - Fax:
Practice Address - Street 1:26520 GRAND RIVER AVE STE 103
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48240-1506
Practice Address - Country:US
Practice Address - Phone:313-282-1961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERSONALIZED NURSING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management