Provider Demographics
NPI:1588904981
Name:PRESTIGE PREMIUM HOMECARE, INC.
Entity type:Organization
Organization Name:PRESTIGE PREMIUM HOMECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-933-1694
Mailing Address - Street 1:6901 DODGE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-2759
Mailing Address - Country:US
Mailing Address - Phone:402-933-1694
Mailing Address - Fax:402-933-1418
Practice Address - Street 1:6901 DODGE ST STE 102
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-2759
Practice Address - Country:US
Practice Address - Phone:402-933-1694
Practice Address - Fax:402-933-1418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care