Provider Demographics
NPI:1366922122
Name:PRECIOUS HEALTH CARE SERVICES INC.
Entity type:Organization
Organization Name:PRECIOUS HEALTH CARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRECIOUS
Authorized Official - Middle Name:ALICIA
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-626-3306
Mailing Address - Street 1:7003 BROOKLINE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34951-1232
Mailing Address - Country:US
Mailing Address - Phone:772-626-3306
Mailing Address - Fax:
Practice Address - Street 1:7003 BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34951-1232
Practice Address - Country:US
Practice Address - Phone:772-626-3306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL725453Medicaid