=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437519527
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRESTIGE HOMEHEALTH SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2016
-----------------------------------------------------
Last Update Date | 03/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 247 FOX GLEN DR E
-----------------------------------------------------
City | PICKERINGTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43147-7798
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-787-1425
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 247 FOX GLEN DR E
-----------------------------------------------------
City | PICKERINGTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43147-7798
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-787-1425
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGISTERED NURSE
-----------------------------------------------------
Name | ESTHER ASHU TATAW-BIAKA
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 419-787-1425
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 3864225
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------