Provider Demographics
NPI:1700144847
Name:PRESTONWOOD HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:PRESTONWOOD HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELESTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:OGBOLUGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-757-4217
Mailing Address - Street 1:134 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-5713
Mailing Address - Country:US
Mailing Address - Phone:469-757-4217
Mailing Address - Fax:972-745-2390
Practice Address - Street 1:134 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-5713
Practice Address - Country:US
Practice Address - Phone:469-757-4217
Practice Address - Fax:972-745-2390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX015044251E00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX293993601Medicaid
TX747650Medicare Oscar/Certification