Healthcare Provider Details

I. General information

NPI: 1174404958
Provider Name (Legal Business Name): PRESTIGE IN HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 N MCDOWELL BLVD
PETALUMA CA
94954-1116
US

IV. Provider business mailing address

1364 N MCDOWELL BLVD
PETALUMA CA
94954-1116
US

V. Phone/Fax

Practice location:
  • Phone: 707-806-8982
  • Fax:
Mailing address:
  • Phone: 707-806-8982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MEREANI IKANIVERE
Title or Position: CEO
Credential:
Phone: 707-774-1424