Provider Demographics
NPI:1720662356
Name:PRECIOUS SAPPHIRES HEALTHCARE INC
Entity Type:Organization
Organization Name:PRECIOUS SAPPHIRES HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADEPEMI
Authorized Official - Middle Name:MOJISOLA
Authorized Official - Last Name:SIYANBOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-824-0495
Mailing Address - Street 1:10451 MILL RUN CIR STE 400
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5594
Mailing Address - Country:US
Mailing Address - Phone:443-824-0495
Mailing Address - Fax:
Practice Address - Street 1:10451 MILL RUN CIR STE 400
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5594
Practice Address - Country:US
Practice Address - Phone:443-824-0495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD20048997Medicaid