Provider Demographics
NPI:1114309226
Name:PRESTIGE CARE SERVICES CORPORATION
Entity Type:Organization
Organization Name:PRESTIGE CARE SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-471-4909
Mailing Address - Street 1:24001 SOUTHFIELD RD STE L200
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2817
Mailing Address - Country:US
Mailing Address - Phone:313-471-4909
Mailing Address - Fax:
Practice Address - Street 1:24001 SOUTHFIELD RD STE L200
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2817
Practice Address - Country:US
Practice Address - Phone:313-471-4909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI06599K251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management