Provider Demographics
NPI:1972002988
Name:PRESTIGE HOME HEALTH TEAM
Entity Type:Organization
Organization Name:PRESTIGE HOME HEALTH TEAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:314-503-6610
Mailing Address - Street 1:1515 N WARSON RD STE 287
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-1165
Mailing Address - Country:US
Mailing Address - Phone:314-503-6610
Mailing Address - Fax:314-942-7399
Practice Address - Street 1:1515 N WARSON RD STE 287
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-1165
Practice Address - Country:US
Practice Address - Phone:314-503-6610
Practice Address - Fax:314-942-7399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-05
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty