Provider Demographics
NPI:1285945469
Name:PRECIOUS ONES PERSONAL CARE HOME INC.
Entity type:Organization
Organization Name:PRECIOUS ONES PERSONAL CARE HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-498-5425
Mailing Address - Street 1:20944 US HWY 84 EAST
Mailing Address - Street 2:PRECIOUS ONES PERSONAL CARE HOME INC.
Mailing Address - City:BOSTON
Mailing Address - State:GA
Mailing Address - Zip Code:31626
Mailing Address - Country:US
Mailing Address - Phone:229-498-5425
Mailing Address - Fax:229-263-9820
Practice Address - Street 1:20944 US HWY 84 EAST
Practice Address - Street 2:PRECIOUS ONES PERSONAL CARE HOME INC.
Practice Address - City:BOSTON
Practice Address - State:GA
Practice Address - Zip Code:31626
Practice Address - Country:US
Practice Address - Phone:229-498-5425
Practice Address - Fax:229-263-9820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA136-01-097-1320600000X, 332B00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA084790774CMedicaid
GA084790774AMedicaid
GA084790774BMedicaid