- Enrollment id
- O20120309000055
- Enrollment state
- TX
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1689972457
- Multiple npi flag
- N
- Ccn
- 747837
- Associate id
- 8729247838
- Organization name
- PRESTIGE HOME HEALTH SERVICES, LLC
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 400 E. 2ND STREET
- Address line 2
- SUITE A
- City
- RIO GRANDE CITY
- State
- TX
- Zip code
- 785825676