03D1100072 CLIA NUMBER - PRESTIGE HOME CARE

Laboratory Demographics

CLIA Number: 03D1100072

Facility Name: PRESTIGE HOME CARE

Facility Address:
3120 NORTH 19TH AVENUE SUITE 170
PHOENIX, AZ
ZIP 85015
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Facility Phone Number: 602 279-8471

Facility Type: Home Health Agency

Certificate Type: Waiver

NPI Number: 1275783003

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name	Field Value
CLIA Number	03D1100072
LAB Type	Home Health Agency
Facility Name	PRESTIGE HOME CARE
Street	3120 NORTH 19TH AVENUE SUITE 170
City	PHOENIX
State	AZ
ZIP	85015
Phone	602 279-8471
CertificateType	4
CertificateEffectiveDate	5/28/2023
CertificateExpirationDate	5/27/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024