MEDICARE: PRESTIGE HAVEN CARE SERVICES

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	:	1740070432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTIGE HAVEN CARE SERVICES

Provider Business Mailing Address
First Line	:	4824 S US HIGHWAY 1
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-7013
Country	:	US
Telephone Number	:	772-646-3006
Fax Number	:	772-273-4353

Provider Business Practice Location Address
First Line	:	4824 S US HIGHWAY 1
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-7013
Country	:	US
Telephone Number	:	772-646-3006
Fax Number	:	772-273-4353

Authorized Official
Title or Position	:	OWNER
Name	:	MANOUCHEKA FAVARD
Credential	:
Telephone Number	:	772-646-3006

Provider Enumeration Date	:	05/07/2025
Last Update Date	:	05/07/2025

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