Provider Demographics
NPI:1508200999
Name:PRECIOUS LIVING SPRING TEXAS CORPORATION
Entity Type:Organization
Organization Name:PRECIOUS LIVING SPRING TEXAS CORPORATION
Other - Org Name:PRECIOUS LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DON
Authorized Official - Prefix:
Authorized Official - First Name:PRECIOUS
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-332-7235
Mailing Address - Street 1:1324 LEMM ROAD 2
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-5788
Mailing Address - Country:US
Mailing Address - Phone:832-332-7235
Mailing Address - Fax:866-493-4007
Practice Address - Street 1:1324 LEMM ROAD 2
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-5788
Practice Address - Country:US
Practice Address - Phone:832-332-7235
Practice Address - Fax:866-493-4007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 251F00000X, 253Z00000X, 302F00000X
TX251E00000X, 310400000X
TX04447251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicaid
TXPENDINGMedicaid