Healthcare Provider Details

I. General information

NPI: 1194579268
Provider Name (Legal Business Name): RTB PRESTIGE GLOBAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4844 GUILFORD AVE
INDIANAPOLIS IN
46205-1958
US

IV. Provider business mailing address

4907 CRITTENDEN AVE
INDIANAPOLIS IN
46205-1356
US

V. Phone/Fax

Practice location:
  • Phone: 765-412-1390
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT SCUBELEK
Title or Position: OWNER
Credential: OG
Phone: 765-412-1390