1235701137 NPI number — PRECISION HOME CARE LLC

Table of content: (NPI 1235701137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235701137 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:
1235701137
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12352 ROSE HAVEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46235-6058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-763-2290
Provider Business Mailing Address Fax Number:
240-542-4047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5722 LITTLE SPRING WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21704-6704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-763-2290
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BAMPEBUYE
Authorized Official First Name:
SHADRACK
Authorized Official Middle Name:
JORAM
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
202-763-2290

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385HR2055X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385HR2060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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