Healthcare Provider Details

I. General information

NPI: 1790602548
Provider Name (Legal Business Name): PRESTIGECARE HOME HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2219 S MOUNTAIN AVE
ONTARIO CA
91762-6133
US

IV. Provider business mailing address

12709 FOOTHILL BLVD
RANCHO CUCAMONGA CA
91739-9761
US

V. Phone/Fax

Practice location:
  • Phone: 833-755-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JAYDEN BURTON
Title or Position: CEO
Credential:
Phone: 833-755-2273