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General NPI Number Information
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NPI Number | 1740960780
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Entity Type | Organization
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Legal Business Name | PRESTIGE HOME CARE
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Dates
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Enumeration Date | 07/24/2023
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Last Update Date | 07/24/2023
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Provider Practice Location Address
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Address Line | 3911 NORA ST # A
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City | POCATELLO
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State | ID
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Zip | 83204-2021
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Country | US
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Telephone | 208-252-8851
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 821
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City | POCATELLO
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State | ID
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Zip | 83204-0821
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Country | US
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Telephone | 208-252-8851
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSH HESS
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Credential |
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Telephone | 208-252-8851
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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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