Provider Demographics
NPI:1700942687
Name:PRESTIGE CARE, LLC
Entity Type:Organization
Organization Name:PRESTIGE CARE, LLC
Other - Org Name:FERNCREST MANOR LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:HARDY
Authorized Official - Last Name:BOHNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-246-1426
Mailing Address - Street 1:14500 HAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70128-1751
Mailing Address - Country:US
Mailing Address - Phone:504-246-1426
Mailing Address - Fax:504-246-1591
Practice Address - Street 1:14500 HAYNE BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70128-1751
Practice Address - Country:US
Practice Address - Phone:504-246-1426
Practice Address - Fax:504-246-1591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA459314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1520292Medicaid
LA195214Medicare UPIN