Provider Demographics
NPI:1306483524
Name:PRECIOUS SAPPHIRES HEALTHCARE INC
Entity type:Organization
Organization Name:PRECIOUS SAPPHIRES HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADEPEMI
Authorized Official - Middle Name:MOJISOLA
Authorized Official - Last Name:SIYANBOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-824-0495
Mailing Address - Street 1:875 ROUTE 73 N STE F
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1273
Mailing Address - Country:US
Mailing Address - Phone:443-824-0495
Mailing Address - Fax:
Practice Address - Street 1:875 ROUTE 73 N STE F
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1273
Practice Address - Country:US
Practice Address - Phone:856-266-0328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-06
Last Update Date:2023-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJNJ95761Medicaid