Provider Demographics
NPI:1801022140
Name:PRESTIGIOUS HOME HEALTH, INC.
Entity Type:Organization
Organization Name:PRESTIGIOUS HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTUDILLO
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN
Authorized Official - Phone:626-722-0279
Mailing Address - Street 1:1074 PARK VIEW DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-3749
Mailing Address - Country:US
Mailing Address - Phone:626-722-0279
Mailing Address - Fax:626-722-0284
Practice Address - Street 1:1074 PARK VIEW DR
Practice Address - Street 2:SUITE 103
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3749
Practice Address - Country:US
Practice Address - Phone:626-722-0279
Practice Address - Fax:626-722-0284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000918251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059193Medicare Oscar/Certification