Healthcare Provider Details

I. General information

NPI: 1508633561
Provider Name (Legal Business Name): PRESTIGE HEALTHCARE SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2023
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3140 NORTHDALE BLVD NW APT 120
COON RAPIDS MN
55433-0005
US

IV. Provider business mailing address

6417 PENN AVE S STE 7
MINNEAPOLIS MN
55423-1196
US

V. Phone/Fax

Practice location:
  • Phone: 612-443-8210
  • Fax:
Mailing address:
  • Phone: 612-443-8210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ASHA AHMED
Title or Position: OWNER
Credential:
Phone: 612-443-8210