Provider Demographics
NPI:1407460462
Name:PRESTIGE HOME HEALTHCARE
Entity Type:Organization
Organization Name:PRESTIGE HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ NURSE TECH II
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE TECH II
Authorized Official - Phone:336-327-8854
Mailing Address - Street 1:PO BOX 36053
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27416-6053
Mailing Address - Country:US
Mailing Address - Phone:336-327-8854
Mailing Address - Fax:336-851-2557
Practice Address - Street 1:3300 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-3156
Practice Address - Country:US
Practice Address - Phone:336-327-8854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-06
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health