Provider Demographics
NPI:1407552656
Name:PRESTIGE HOMEMAKER & COMPANION CARE AGENCY
Entity Type:Organization
Organization Name:PRESTIGE HOMEMAKER & COMPANION CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLUM TYEHIBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-245-1697
Mailing Address - Street 1:4625 LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-1620
Mailing Address - Country:US
Mailing Address - Phone:239-245-1697
Mailing Address - Fax:
Practice Address - Street 1:4625 LEE BLVD
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1620
Practice Address - Country:US
Practice Address - Phone:239-245-1697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care