Provider Demographics
NPI:1356597728
Name:PRECIOUS CLEO HEALTH SERVICES INC.
Entity type:Organization
Organization Name:PRECIOUS CLEO HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAMAWO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-664-5025
Mailing Address - Street 1:7206 LINCOLN HEIGHTS CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-3855
Mailing Address - Country:US
Mailing Address - Phone:631-664-5025
Mailing Address - Fax:
Practice Address - Street 1:7206 LINCOLN HEIGHTS CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-3855
Practice Address - Country:US
Practice Address - Phone:631-664-5025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-17
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747206Medicare PIN