39D0938826 CLIA NUMBER - PRESTIGE HOME CARE AGENCY

Laboratory Demographics

CLIA Number: 39D0938826

Facility Name: PRESTIGE HOME CARE AGENCY

Facility Address:
10890 BUSTLETON AVENUE STE 211
PHILADELPHIA, PA
ZIP 19116
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Facility Phone Number: 215 677-3299

Facility Type: Home Health Agency

Certificate Type: Waiver

NPI Number: 1063426831

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	39D0938826
LAB Type	Home Health Agency
Facility Name	PRESTIGE HOME CARE AGENCY
Street	10890 BUSTLETON AVENUE STE 211
City	PHILADELPHIA
State	PA
ZIP	19116
Phone	215 677-3299
CertificateType	4
CertificateEffectiveDate	1/15/2024
CertificateExpirationDate	1/14/2026
FacilityType	Waiver

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