Provider Demographics
NPI:1194166074
Name:PRECIOUS MOMENTS LLC
Entity type:Organization
Organization Name:PRECIOUS MOMENTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNERS
Authorized Official - Prefix:
Authorized Official - First Name:CARESA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON HAYNESWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-550-7272
Mailing Address - Street 1:4701 81ST ST
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23605-1621
Mailing Address - Country:US
Mailing Address - Phone:757-550-7272
Mailing Address - Fax:
Practice Address - Street 1:4701 81ST ST
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23605-1621
Practice Address - Country:US
Practice Address - Phone:757-550-7272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities