Healthcare Provider Details

I. General information

NPI: 1063247385
Provider Name (Legal Business Name): PRESTIGE CARE HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 WATT AVE STE 320-A
SACRAMENTO CA
95825-0508
US

IV. Provider business mailing address

15241 MURIETA SOUTH PKWY
RNCHO MURIETA CA
95683-9109
US

V. Phone/Fax

Practice location:
  • Phone: 916-753-4133
  • Fax:
Mailing address:
  • Phone: 916-753-4133
  • 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: MANOLITO AQUINO
Title or Position: MANAGING MEMBER
Credential:
Phone: 916-753-4133