Organization Active NPI

Prestige Health Care Services, Inc

  • Home Health Agency
  • Columbus, OH
National Provider Identifier
1235649062
Registry record updated Apr 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
PRESTIGE HEALTH CARE SERVICES, INC
Practice address
1520 Old Henderson Rd Ste 100a
Columbus, OH 43220-3671
Phone
(508) 488-7849
NPI assigned
Oct 6, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Isdory Lyamuya
Title
Ceo
Phone
(508) 488-7849

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

1520 Old Henderson Rd Ste 100a
Columbus, OH 43220-3671

Mailing address

1520 Old Henderson Rd Ste 100a
Columbus, OH 43220-3671
Phone (508) 488-7849

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180209000771 OH Part A Provider - Home Health Agency 7012277171 Practice locations: Columbus, OH

Home health agency certification: CCN 369211

Legal name
PRESTIGE HEALTH CARE SERVICES INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Mar 13, 2019
Last certification
Mar 13, 2019
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Enrollment address
1520 Old Henderson Rd
Ste 100a
Columbus, OH 43220-3671

Care Compare: Home health agency

Medicare Care Compare
Listed as
Prestige Health Care Services IncCCN 369211
Ownership
Proprietary
Certified
Mar 13, 2019
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Locations

1520 Old Henderson Rd
Ste 100A
Columbus, OH 43220
Phone (508) 488-7849

6161 Busch Blvd
Ste 70
Columbus, OH 43229

665 E Dublin Granville Rd
Ste 320
Columbus, OH 43229

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Isdory P Lyamuya Individual 5% Or Greater Direct Ownership Interest100 Oct 3, 2017
Corporate OfficerCeo Oct 3, 2017 100%
W-2 Managing EmployeeCeo Oct 3, 2017

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1507248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712361600000",
    "number": "1235649062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 OLD HENDERSON RD STE 100A",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432203671",
            "telephone_number": "508-488-7849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 OLD HENDERSON RD STE 100A",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432203671",
            "telephone_number": "508-488-7849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTIGE HEALTH CARE SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-06",
        "last_updated": "2024-04-06",
        "certification_date": "2024-04-06",
        "status": "A",
        "authorized_official_last_name": "LYAMUYA",
        "authorized_official_first_name": "ISDORY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "508-488-7849"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, OH

Sources for this page

Verify at the official NPI Registry.