Provider Demographics
NPI:1770040883
Name:PRECIOUS GROUP HOME CARE LLC
Entity Type:Organization
Organization Name:PRECIOUS GROUP HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:UZOMBA
Authorized Official - Suffix:
Authorized Official - Credentials:MSA
Authorized Official - Phone:512-541-1606
Mailing Address - Street 1:2200 S BAGDAD RD
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-2818
Mailing Address - Country:US
Mailing Address - Phone:512-541-1606
Mailing Address - Fax:512-221-2927
Practice Address - Street 1:2200 S BAGDAD RD
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-2818
Practice Address - Country:US
Practice Address - Phone:512-541-1606
Practice Address - Fax:512-221-2927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-25
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX307141Medicaid
TXAF500305610OtherMANAGED CARE ORGANIZATION