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General NPI Number Information
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NPI Number | 1881030385
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Entity Type | Organization
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Legal Business Name | PRESTIGE PLUS
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Dates
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Enumeration Date | 05/12/2013
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Last Update Date | 05/13/2013
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Provider Practice Location Address
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Address Line | 2714 HEBRON AVE C
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City | ZION
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State | IL
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Zip | 60099-2487
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Country | US
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Telephone | 224-717-0183
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Fax |
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Provider Business Mailing Address
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Address Line | 2714 HEBRON AVE C
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City | ZION
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State | IL
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Zip | 60099-2487
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Country | US
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Telephone | 224-717-0183
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. OLUWAKEMI IYABODE SULAIMON
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Credential | PCT
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Telephone | 224-717-0183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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