Provider Demographics
NPI:1295112555
Name:PRECIOUS KEY HOME CARE AGENCY
Entity type:Organization
Organization Name:PRECIOUS KEY HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:TACKIE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:917-324-7989
Mailing Address - Street 1:1680 METROPOLITAN AVE
Mailing Address - Street 2:5D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-6982
Mailing Address - Country:US
Mailing Address - Phone:917-324-7989
Mailing Address - Fax:
Practice Address - Street 1:1680 METROPOLITAN AVE
Practice Address - Street 2:5D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-6982
Practice Address - Country:US
Practice Address - Phone:917-324-7989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314108251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care