MEDICARE: PRESTIGE 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	314000000X	Skilled Nursing Facility	459	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700942687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTIGE CARE, LLC

Provider Business Mailing Address
First Line	:	14500 HAYNE BLVD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70128-1751
Country	:	US
Telephone Number	:	504-246-1426
Fax Number	:	504-246-1591

Provider Business Practice Location Address
First Line	:	14500 HAYNE BLVD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70128-1751
Country	:	US
Telephone Number	:	504-246-1426
Fax Number	:	504-246-1591

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	MRS. KIMBERLY HARDY BOHNE
Credential	:
Telephone Number	:	504-246-1426

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	01/28/2013

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Directions to “PRESTIGE CARE, LLC ” Practice Location

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