Provider Demographics
NPI:1942255583
Name:PRESTIGE HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:PRESTIGE HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-693-0100
Mailing Address - Street 1:8618 W CATALPA AVE
Mailing Address - Street 2:SUITE 1115
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-1705
Mailing Address - Country:US
Mailing Address - Phone:773-693-0100
Mailing Address - Fax:773-693-0110
Practice Address - Street 1:8618 W CATALPA AVE
Practice Address - Street 2:SUITE 1115
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-1705
Practice Address - Country:US
Practice Address - Phone:773-693-0100
Practice Address - Fax:773-693-0110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010242251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147742Medicare ID - Type UnspecifiedHOME HEALTH AGENCY