Provider Demographics
NPI:1881030385
Name:PRESTIGE PLUS
Entity Type:Organization
Organization Name:PRESTIGE PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLUWAKEMI
Authorized Official - Middle Name:IYABODE
Authorized Official - Last Name:SULAIMON
Authorized Official - Suffix:
Authorized Official - Credentials:PCT
Authorized Official - Phone:224-717-0183
Mailing Address - Street 1:2714 HEBRON AVE
Mailing Address - Street 2:C
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099-2487
Mailing Address - Country:US
Mailing Address - Phone:224-717-0183
Mailing Address - Fax:
Practice Address - Street 1:2714 HEBRON AVE
Practice Address - Street 2:C
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099-2487
Practice Address - Country:US
Practice Address - Phone:224-717-0183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-12
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)