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General NPI Number Information
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NPI Number | 1861274680
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Entity Type | Organization
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Legal Business Name | PRESTIGIOUS NURSE HEALTHCARE LLC
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Dates
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Enumeration Date | 10/17/2023
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 2816 CLEARVIEW DR
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City | JOLIET
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State | IL
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Zip | 60436-9759
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Country | US
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Telephone | 317-979-3601
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Fax |
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Provider Business Mailing Address
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Address Line | 992 BROOK FOREST AVE # 1112
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City | SHOREWOOD
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State | IL
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Zip | 60404-8807
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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 | OWNER
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Name | TAMRA PACKER
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Credential |
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Telephone | 317-979-3601
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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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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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