Provider Demographics
NPI:1902287873
Name:GOD'S PRECIOUS TREASURES
Entity Type:Organization
Organization Name:GOD'S PRECIOUS TREASURES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MAZYCK-SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:LLMSW
Authorized Official - Phone:734-787-8536
Mailing Address - Street 1:46151 VILLAGE GREEN LN
Mailing Address - Street 2:APT. B 302
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-3177
Mailing Address - Country:US
Mailing Address - Phone:734-787-8536
Mailing Address - Fax:
Practice Address - Street 1:46151 VILLAGE GREEN LN
Practice Address - Street 2:APT. B 302
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-3177
Practice Address - Country:US
Practice Address - Phone:734-787-8536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health