Provider Demographics
NPI:1265826895
Name:PRESTIGE FAMILY CARE HOMES, INC
Entity Type:Organization
Organization Name:PRESTIGE FAMILY CARE HOMES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATIENCE
Authorized Official - Middle Name:CHILE
Authorized Official - Last Name:NDIKOM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:919-201-3265
Mailing Address - Street 1:1420 E CLUB BLVD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-4622
Mailing Address - Country:US
Mailing Address - Phone:919-201-3265
Mailing Address - Fax:919-596-6866
Practice Address - Street 1:3217 DEARBORN DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2344
Practice Address - Country:US
Practice Address - Phone:919-201-3265
Practice Address - Fax:919-596-6866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-032-141311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home