1275012338 NPI number — PRECISION HOME CARE LLC

Table of content: (NPI 1275012338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275012338 NPI number — PRECISION HOME CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRECISION HOME CARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275012338
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1879 LUNDY AVE STE 129
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95131-1877
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2450 VENTURE OAKS WAY STE 220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95833-4225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-749-4051
Provider Business Practice Location Address Fax Number:
916-604-9253
Provider Enumeration Date:
08/09/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BLISS
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
408-609-0245

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  314700003 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 314700003 . This is a "PRIVATE DUTY HOME CARE LICENSE (CDPH)" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".