Provider Demographics
NPI:1063815868
Name:PRESTIGUE HEALTH CARE SERVICE
Entity Type:Organization
Organization Name:PRESTIGUE HEALTH CARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:864-316-4690
Mailing Address - Street 1:364 S PINE ST
Mailing Address - Street 2:240B
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-2655
Mailing Address - Country:US
Mailing Address - Phone:864-316-4690
Mailing Address - Fax:
Practice Address - Street 1:364 S PINE ST
Practice Address - Street 2:240B
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-2655
Practice Address - Country:US
Practice Address - Phone:864-316-4690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC=========OtherEIN NUMBER