Provider Demographics
NPI:1346779618
Name:PRESTIGE COMPANION & HOMEMAKERS, LLC
Entity type:Organization
Organization Name:PRESTIGE COMPANION & HOMEMAKERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:APPIAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-262-0046
Mailing Address - Street 1:77 MAIN ST N UNIT 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2200
Mailing Address - Country:US
Mailing Address - Phone:203-262-0046
Mailing Address - Fax:203-262-0047
Practice Address - Street 1:77 MAIN ST N UNIT 100
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2200
Practice Address - Country:US
Practice Address - Phone:203-262-0046
Practice Address - Fax:203-262-0047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
CT0000617376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008056979OtherMEDICAID
CT008056979Medicaid
CT008067809Medicaid