- Enrollment id
- O20240503002481
- Enrollment state
- NV
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1710742010
- Multiple npi flag
- N
- Ccn
- 297358
- Associate id
- 8628418845
- Organization name
- PRESTIGE CARE OF NEVADA LLC
- Incorporation date
- 2022-04-04
- Incorporation state
- NV
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 1771 E FLAMINGO RD
- Address line 2
- STE 122B
- City
- LAS VEGAS
- State
- NV
- Zip code
- 891190839
- Practice location type
- HHA BRANCH