Healthcare Provider Details

I. General information

NPI: 1205531597
Provider Name (Legal Business Name): PRESTIGIOUS HANDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1449 S MICHIGAN AVE UNIT 435
CHICAGO IL
60605-2810
US

IV. Provider business mailing address

1645 DOWNS DR APT 3E
CALUMET CITY IL
60409-1531
US

V. Phone/Fax

Practice location:
  • Phone: 773-993-6375
  • Fax:
Mailing address:
  • Phone: 773-993-6375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: SHANTEL CARTEL CARTER
Title or Position: PRESIDENT
Credential:
Phone: 773-993-6375