Provider Demographics
NPI:1326829722
Name:PRESTIGIOUS HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:PRESTIGIOUS HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-499-0000
Mailing Address - Street 1:1315 IVY MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-9010
Mailing Address - Country:US
Mailing Address - Phone:704-499-0000
Mailing Address - Fax:
Practice Address - Street 1:3151 WINESAP DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:NC
Practice Address - Zip Code:28034-9633
Practice Address - Country:US
Practice Address - Phone:704-499-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2883Medicaid
HC6456OtherLICENSURE FOR NON-CERTIFIED HOME CARE SERVICES