Provider Demographics
NPI:1518045988
Name:PRESTIGE HOME CARE SERVICES OF BROWARD, INC
Entity Type:Organization
Organization Name:PRESTIGE HOME CARE SERVICES OF BROWARD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LIZARAZO
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:954-926-2595
Mailing Address - Street 1:2450 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020
Mailing Address - Country:US
Mailing Address - Phone:954-926-2595
Mailing Address - Fax:954-926-6742
Practice Address - Street 1:2450 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020
Practice Address - Country:US
Practice Address - Phone:954-926-2595
Practice Address - Fax:954-926-6742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992546251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116408900Medicaid