Provider Demographics
NPI:1942800198
Name:PRECIOUS GEMS HOMES @ POLO DR
Entity Type:Organization
Organization Name:PRECIOUS GEMS HOMES @ POLO DR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE/OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:SYREETA
Authorized Official - Middle Name:
Authorized Official - Last Name:DWEH-CHENNEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:177-436-1405
Mailing Address - Street 1:5502 POLO DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-2752
Mailing Address - Country:US
Mailing Address - Phone:774-361-4056
Mailing Address - Fax:
Practice Address - Street 1:5502 POLO DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-2752
Practice Address - Country:US
Practice Address - Phone:774-361-4056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility