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General NPI Number Information
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NPI Number | 1861715120
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Entity Type | Organization
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Legal Business Name | PRESTIGE HOME CARE OF KANSAS
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Dates
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Enumeration Date | 03/01/2010
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Last Update Date | 03/01/2010
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Provider Practice Location Address
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Address Line | 515 DELAWARE ST
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City | LEAVENWORTH
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State | KS
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Zip | 66048-2642
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Country | US
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Telephone | 913-680-0493
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Fax |
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Provider Business Mailing Address
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Address Line | 515 DELAWARE ST
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City | LEAVENWORTH
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State | KS
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Zip | 66048-2642
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Country | US
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Telephone | 913-680-0493
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/ADMINISTRATOR
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Name | MRS. GERI MARTIN
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Credential | ARNP
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Telephone | 913-780-0493
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | A052010
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License Number State | KS
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