Provider Demographics
NPI:1942032495
Name:PRESTIGE HOMEHEALTHCARE SERVICES
Entity type:Organization
Organization Name:PRESTIGE HOMEHEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:OTUBUAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-736-3326
Mailing Address - Street 1:11810 GRAND PARK AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-8679
Mailing Address - Country:US
Mailing Address - Phone:508-736-3326
Mailing Address - Fax:
Practice Address - Street 1:11810 GRAND PARK AVE STE 500
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-8679
Practice Address - Country:US
Practice Address - Phone:301-366-1417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health