Healthcare Provider Details

I. General information

NPI: 1881030385
Provider Name (Legal Business Name): PRESTIGE PLUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2013
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2714 HEBRON AVE C
ZION IL
60099-2487
US

IV. Provider business mailing address

2714 HEBRON AVE C
ZION IL
60099-2487
US

V. Phone/Fax

Practice location:
  • Phone: 224-717-0183
  • Fax:
Mailing address:
  • Phone: 224-717-0183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. OLUWAKEMI IYABODE SULAIMON
Title or Position: CEO
Credential: PCT
Phone: 224-717-0183