MEDICARE: PRESTIGE COMFORT HOME CARE 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1922638964
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTIGE COMFORT HOME CARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 307514
Second Line	:
City	:	GAHANNA
State	:	OH
Zip	:	43230-7514
Country	:	US
Telephone Number	:	614-758-7700
Fax Number	:	404-795-7118

Provider Business Practice Location Address
First Line	:	3993 LEATHER STOCKING TRL
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-1528
Country	:	US
Telephone Number	:	614-806-8647
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	JACQUELINE REAVES
Credential	:
Telephone Number	:	614-758-7700

Provider Enumeration Date	:	01/17/2020
Last Update Date	:	02/16/2020

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