Provider Demographics
NPI:1174291686
Name:PRESTIGE HOME CARE LLC
Entity Type:Organization
Organization Name:PRESTIGE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARQUALIA
Authorized Official - Middle Name:NA'SHAI
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-482-8917
Mailing Address - Street 1:2608 ERWIN RD STE 148-282
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4596
Mailing Address - Country:US
Mailing Address - Phone:919-482-8917
Mailing Address - Fax:
Practice Address - Street 1:5706 TERRIER PL
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6367
Practice Address - Country:US
Practice Address - Phone:919-482-8917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care