MEDICARE: PRESTIGE LIVING CENTER 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	008656	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568509701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTIGE LIVING CENTER INC.

Provider Business Mailing Address
First Line	:	6206 SANFORD RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-5729
Country	:	US
Telephone Number	:	832-274-8636
Fax Number	:	713-772-0701

Provider Business Practice Location Address
First Line	:	6206 SANFORD RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-5729
Country	:	US
Telephone Number	:	832-274-8636
Fax Number	:	713-772-0701

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	VERONICA E. OBOMESE
Credential	:
Telephone Number	:	832-274-8636

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	08/12/2008

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