Provider Demographics
NPI:1255424909
Name:PRESTIGE HOME HEALTH SERVICES, CORP
Entity type:Organization
Organization Name:PRESTIGE HOME HEALTH SERVICES, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELICA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CABALLERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-468-9017
Mailing Address - Street 1:7220 NW 36TH ST
Mailing Address - Street 2:SUITE 307A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166
Mailing Address - Country:US
Mailing Address - Phone:305-468-9017
Mailing Address - Fax:
Practice Address - Street 1:7220 NW 36TH ST
Practice Address - Street 2:SUITE 307A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166
Practice Address - Country:US
Practice Address - Phone:305-468-9017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHH299992085251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6511929Medicaid
FL108271Medicare ID - Type UnspecifiedMEDICARE NUMBER