Provider Demographics
NPI:1922278258
Name:PRESTIGE HOME HEALTHCARE, INC
Entity type:Organization
Organization Name:PRESTIGE HOME HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:UJU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-233-9057
Mailing Address - Street 1:9944 S. ROBERTS RD
Mailing Address - Street 2:STE 101
Mailing Address - City:PALOS HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60465
Mailing Address - Country:US
Mailing Address - Phone:708-233-9057
Mailing Address - Fax:708-233-9058
Practice Address - Street 1:9944 S. ROBERTS RD
Practice Address - Street 2:STE 101
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465
Practice Address - Country:US
Practice Address - Phone:708-233-9057
Practice Address - Fax:708-233-9058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 376J00000X
IL1010829251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1010829Medicaid
IL3001555Medicaid