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General NPI Number Information
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NPI Number | 1194470112
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Entity Type | Organization
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Legal Business Name | PRESTIGE CARE AT HOME, LLC
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Dates
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Enumeration Date | 02/17/2022
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Last Update Date | 02/17/2022
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Provider Practice Location Address
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Address Line | 919 FAIRFAX ST STE 200
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City | ALTOONA
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State | WI
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Zip | 54720-1194
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Country | US
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Telephone | 715-318-6860
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Fax |
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Provider Business Mailing Address
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Address Line | 211 N WILLSON DR
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City | ALTOONA
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State | WI
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Zip | 54720-2199
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SOPHIA SMITH
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Credential | NP
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Telephone | 715-318-6860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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