MEDICARE: PRESTIGE HEALTH CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1033999339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTIGE HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	13805 PORTLAND AVE
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-4659
Country	:	US
Telephone Number	:	651-324-1660
Fax Number	:

Provider Business Practice Location Address
First Line	:	13805 PORTLAND AVE
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-4659
Country	:	US
Telephone Number	:	651-324-1660
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	IMAAN HASSAN
Credential	:
Telephone Number	:	651-324-1660

Provider Enumeration Date	:	10/03/2023
Last Update Date	:	10/03/2023

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