Provider Demographics
NPI:1275783003
Name:PRESTIGE HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:PRESTIGE HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOLAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:OGUNDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-739-7170
Mailing Address - Street 1:PO BOX 18951
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85005-8951
Mailing Address - Country:US
Mailing Address - Phone:602-279-8471
Mailing Address - Fax:602-279-0296
Practice Address - Street 1:3120 N 19TH AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-6052
Practice Address - Country:US
Practice Address - Phone:602-279-8471
Practice Address - Fax:602-279-0296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health