Provider Demographics
NPI:1154312361
Name:PRESTIGE HEALTH SERVICES,INC
Entity Type:Organization
Organization Name:PRESTIGE HEALTH SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALTERNATE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:REUBEN
Authorized Official - Middle Name:AMAEFUNA
Authorized Official - Last Name:NWOKOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-774-1195
Mailing Address - Street 1:9888 BISSONNET ST
Mailing Address - Street 2:STE. # 590
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8247
Mailing Address - Country:US
Mailing Address - Phone:713-774-1195
Mailing Address - Fax:713-774-1830
Practice Address - Street 1:9888 BISSONNET ST
Practice Address - Street 2:STE. # 590
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8247
Practice Address - Country:US
Practice Address - Phone:713-774-1195
Practice Address - Fax:713-774-1830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009286251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX459008Medicare Oscar/Certification