Healthcare Provider Details

I. General information

NPI: 1609259795
Provider Name (Legal Business Name): PRESTIGE LHCSA MANAGEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 E 149TH ST 3RD FL
BRONX NY
10451-5601
US

IV. Provider business mailing address

329 E 149TH ST 3RD FL
BRONX NY
10451-5601
US

V. Phone/Fax

Practice location:
  • Phone: 718-450-8054
  • Fax:
Mailing address:
  • Phone: 718-450-8054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2401L001
License Number StateNY

VIII. Authorized Official

Name: KAYLA SCHEINER
Title or Position: SERVICE CENTER MANAGER
Credential:
Phone: 718-338-8500