RENEWAL OF CERTIFICATION LETTER



RENEWAL OF CERTIFICATION LETTER

August 9, 2011 Provider Specialist: Lottie D. Blazer

|Precious Places LLC |DODD Contract Number: |9801423 |

|6128 Merger Drive Ste B |ODJFS Medicaid Provider Number: |2928710 |

|Holland, OH 43528 |Telephone Number: |419-491-0970 |

| | | |

|Certification Type: Agency | | |

Certification Date: 8-2-11

New Expiration Date: 8-1-14

| | Level 1 | |Individual Options | |

| |Homemaker Personal Care | |Homemaker Personal Care | |

| |Transportation | |Transportation Mileage | |

| |Vocational Habilitation | |Adult Foster Care | |

| |Adult Day Support | |Vocational Habilitation | |

| |Supported Employment Community Services | |Adult Day Support | |

| |Supported Employment Enclave | |Supported Employment Community Services | |

| |Non Medical Transportation Per Trip Rate | |Supported Employment Enclave | |

| | | |Non Medical Transportation Per Trip Rate | |

Dear Provider:

Congratulations! Your application for renewal of your provider certification through the Ohio Department of Developmental Disabilities has been approved. Your certification has been renewed for three years. Please note, it continues to be your responsibility to meet the requirements of the Provider Certification rule, 5123:2-2-01 and other service specific standards and assurances established under Chapter 5123. of the Ohio Administrative Code.

Should you have any questions or require additional information regarding certification, please feel free to contact the provider certification unit via email at Provider.Certification@dodd. or by telephone toll free at 1-800-617-6733

Sincerely,

[pic]

Lottie D. Blazer, Certification Specialist

cc: Office of Provider Standards and Review

Claims Services, Medicaid Development & Administration

County Board of DD

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