Provider Demographics
NPI:1801478391
Name:PRESTIGIOUS HOME CARE LLC
Entity type:Organization
Organization Name:PRESTIGIOUS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KENDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VERTUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-312-9857
Mailing Address - Street 1:100 TRADECENTER SUITE G-700
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801
Mailing Address - Country:US
Mailing Address - Phone:857-222-0682
Mailing Address - Fax:
Practice Address - Street 1:100 TRADECENTER SUITE G-700
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-0180
Practice Address - Country:US
Practice Address - Phone:857-222-0682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care