Provider Demographics
NPI:1497301170
Name:PRESTIGE HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:PRESTIGE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/RN
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLERIZIER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:678-571-2528
Mailing Address - Street 1:2860 SUMMIT VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-4008
Mailing Address - Country:US
Mailing Address - Phone:678-571-2528
Mailing Address - Fax:
Practice Address - Street 1:1770 INDIAN TRAIL LILBURN RD STE 420
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-2644
Practice Address - Country:US
Practice Address - Phone:404-475-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-17
Last Update Date:2019-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000111222333Medicaid