Provider Demographics
NPI:1548676075
Name:PRECIOUS PLACES, LLC
Entity type:Organization
Organization Name:PRECIOUS PLACES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTHCARE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DESHRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-491-0970
Mailing Address - Street 1:6128 MERGER DR
Mailing Address - Street 2:SUITE: B
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-8499
Mailing Address - Country:US
Mailing Address - Phone:419-491-0970
Mailing Address - Fax:419-491-0971
Practice Address - Street 1:1526 W COURT ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-3584
Practice Address - Country:US
Practice Address - Phone:810-233-6696
Practice Address - Fax:810-233-6696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-04
Last Update Date:2014-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0050702Medicaid