Provider Demographics
NPI:1760909840
Name:PRECIOUS PALS INC
Entity Type:Organization
Organization Name:PRECIOUS PALS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR / COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BYNUM
Authorized Official - Suffix:
Authorized Official - Credentials:BA, AA
Authorized Official - Phone:574-386-9757
Mailing Address - Street 1:1139 E LASALLE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-3321
Mailing Address - Country:US
Mailing Address - Phone:574-386-9757
Mailing Address - Fax:574-246-9578
Practice Address - Street 1:1139 E LASALLE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-3321
Practice Address - Country:US
Practice Address - Phone:574-386-9757
Practice Address - Fax:574-246-9578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty