Provider Demographics
NPI:1750899167
Name:PRECIOUS GEMS LLC
Entity type:Organization
Organization Name:PRECIOUS GEMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALTON
Authorized Official - Middle Name:
Authorized Official - Last Name:GUIDRY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:316-390-7026
Mailing Address - Street 1:2735 E FAIRCHILD CT
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67219-1543
Mailing Address - Country:US
Mailing Address - Phone:316-390-7026
Mailing Address - Fax:
Practice Address - Street 1:512 S HORSESHOE BND
Practice Address - Street 2:
Practice Address - City:MAIZE
Practice Address - State:KS
Practice Address - Zip Code:67101-7012
Practice Address - Country:US
Practice Address - Phone:316-390-7026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility