Provider Demographics
NPI:1356115133
Name:PRESTIGE CARE LLC
Entity type:Organization
Organization Name:PRESTIGE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:KEHINDE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARUWA
Authorized Official - Suffix:
Authorized Official - Credentials:BSC RN
Authorized Official - Phone:347-323-5248
Mailing Address - Street 1:18-20 LACKAWANNA PLZ STE 300-45
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3642
Mailing Address - Country:US
Mailing Address - Phone:973-692-7434
Mailing Address - Fax:
Practice Address - Street 1:18-20 LACKAWANNA PLZ STE 300-45
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3642
Practice Address - Country:US
Practice Address - Phone:973-692-7434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based