Provider Demographics
NPI:1225227523
Name:PRESTIGE HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:PRESTIGE HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-479-8448
Mailing Address - Street 1:4915 FULTON DR NW
Mailing Address - Street 2:UNIT #7
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718
Mailing Address - Country:US
Mailing Address - Phone:330-479-8448
Mailing Address - Fax:330-319-7599
Practice Address - Street 1:4915 FULTON DR NW
Practice Address - Street 2:UNIT #7
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718
Practice Address - Country:US
Practice Address - Phone:330-479-8448
Practice Address - Fax:330-319-7599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0117151Medicaid
OH368242Medicare Oscar/Certification
OH368242Medicare UPIN