Provider Demographics
NPI:1063247385
Name:PRESTIGE CARE HOME HEALTH LLC
Entity type:Organization
Organization Name:PRESTIGE CARE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MANOLITO
Authorized Official - Middle Name:
Authorized Official - Last Name:AQUINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-753-4133
Mailing Address - Street 1:15241 MURIETA SOUTH PKWY
Mailing Address - Street 2:
Mailing Address - City:RNCHO MURIETA
Mailing Address - State:CA
Mailing Address - Zip Code:95683-9109
Mailing Address - Country:US
Mailing Address - Phone:916-753-4133
Mailing Address - Fax:
Practice Address - Street 1:2255 WATT AVE STE 320-A
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-0508
Practice Address - Country:US
Practice Address - Phone:916-753-4133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-05
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health