MEDICARE: PRESTIGE CARE HOMES LLC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1750240529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTIGE CARE HOMES LLC

Provider Business Mailing Address
First Line	:	361 MAIDENBROOK LN
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-6822
Country	:	US
Telephone Number	:	916-802-7610
Fax Number	:	833-937-1755

Provider Business Practice Location Address
First Line	:	3405 HUNTSMAN DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95826-4624
Country	:	US
Telephone Number	:	916-802-7610
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	VIDAN LOT BARIAS
Credential	:
Telephone Number	:	916-802-7610

Provider Enumeration Date	:	01/19/2026
Last Update Date	:	01/19/2026

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