MEDICARE: PRESTIGE HOME HEALTH CARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1437424900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTIGE HOME HEALTH CARE, INC

Provider Business Mailing Address
First Line	:	523 W CHICAGO AVE
Second Line	:
City	:	EAST CHICAGO
State	:	IN
Zip	:	46312-3206
Country	:	US
Telephone Number	:	219-354-0801
Fax Number	:	219-354-7080

Provider Business Practice Location Address
First Line	:	523 W CHICAGO AVE
Second Line	:
City	:	EAST CHICAGO
State	:	IN
Zip	:	46312-3206
Country	:	US
Telephone Number	:	219-354-0801
Fax Number	:	219-354-7080

Authorized Official
Title or Position	:	NURSE SUPERVISOR
Name	:	MS. NERI YU
Credential	:
Telephone Number	:	219-354-0801

Provider Enumeration Date	:	03/17/2012
Last Update Date	:	07/10/2014

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