Provider Demographics
NPI:1316738107
Name:PRECIOUS CARE ASSISTED LIVING LLC
Entity type:Organization
Organization Name:PRECIOUS CARE ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:OGOLLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-414-8013
Mailing Address - Street 1:720 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-4904
Mailing Address - Country:US
Mailing Address - Phone:269-414-8013
Mailing Address - Fax:269-312-8216
Practice Address - Street 1:720 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-4904
Practice Address - Country:US
Practice Address - Phone:269-414-8013
Practice Address - Fax:269-312-8216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities